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(See endnote 23)

Tuberculosis continues to be one of the most serious communicable diseases in the world. In 2013, an estimated 9 million people developed the disease and 1.5 million died of whom 360,000 were HIV-positive. Tuberculosis has the potential to be a healthcare-associated infection. It has become a very serious secondary infection for HIV patients as well as a primary infection for healthcare workers infected by people being admitted to hospitals and other healthcare institutions who have not been identified as tuberculosis active or carriers.

Best Practices in Control of Tuberculosis

  • • Screen high-risk patients especially those with productive coughs, and healthcare staff for unrecognized tuberculosis.
  • • Reduce the quantity of infectious airborne particulate droplets going into the general indoor air by proper early identification of individuals who have the disease, proper care including chemotherapy and treatment of individuals, use of isolation rooms and isolation techniques, and personal protective equipment for healthcare workers.
  • • Infectious patients must cover all coughs and sneezes with a tissue and place it in a special bag for highly infectious material.
  • • When the patient is transferred from area to area, he/she should wear a well-fitted impermeable surgical mask which should be disposed of as highly infectious material.
  • • Use special booths with local exhaust ventilation and HEPA filters, which remove almost 100% of airborne particles, for treatment of individuals with tuberculosis where sputum induction or aerosolized medications are part of the treatment process. These treatments can make the area a greater risk for other individuals. The exhaust fan in the booth should maintain negative pressure to avoid aerosol particles from entering adjacent areas.
  • • The general air of the room in which the patient is housed should be continuously diluted with fresh air and the exhaust air should go to the outside away from all air intake vents, people, and animals. The air supply should come from the ceiling at higher pressure and contaminated air should be exhausted near the floor at lower pressure, which produces a constant downward movement of air through the potential contamination zone at the breathing level of the individual.
  • • Ultraviolet radiation is a controversial means of controlling microorganisms. If the ultraviolet lights are used within ductwork and are properly cleaned, they may be effective in destroying microorganisms in the air passing through. However, ultraviolet light used within patient rooms can be quite dangerous and not necessarily effective.
  • • All healthcare personnel should wear proper personal protective equipment including a disposable particulate respirator designed to filter out particulates 1-5 pm in diameter.
  • • Critical items such as surgical instruments, cardiac catheters, etc. should be thoroughly cleaned and then sterilized.
  • • Semi-critical items such as non-invasive endoscopes, bronchoscopes, and anesthesia breathing circuits should be thoroughly cleaned and then sterilized.
  • • Non-critical items such as crutches, frequent touch surfaces, blood pressure cuffs, etc. from an infectious patient should be washed thoroughly with a good detergent before reuse.
  • • Walls, floors, and other surfaces should be washed very thoroughly with a good detergent, rinsed, and then decontaminated.
  • • Establish a tuberculosis screening and prevention program for all healthcare personnel and periodically test them for the disease.
  • • Establish a special surveillance and reporting program for tuberculosis among patients in healthcare facilities. Report the results to the local and state health departments
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