Tuberc Respir Dis.  2016 Oct;79(4):234-240. 10.4046/trd.2016.79.4.234.

Tuberculosis Infection Control in Health-Care Facilities: Environmental Control and Personal Protection

• Lee JY

• KMID: 2365314
• DOI: http://doi.org/10.4046/trd.2016.79.4.234

Abstract

Transmission of tuberculosis (TB) is a recognized risk to patients and healthcare workers in healthcare settings. The literature review suggests that implementation of combination control measures reduces the risk of TB transmission. Guidelines suggest a three-level hierarchy of controls including administrative, environmental, and respiratory protection. Among environmental controls, installation of ventilation systems is a priority because ventilation reduces the number of infectious particles in the air. Natural ventilation is cost-effective but depends on climatic conditions. Supplemented intervention such as air-cleaning methods including high efficiency particulate air filtration and ultraviolet germicidal irradiation should be considered in areas where adequate ventilation is difficult to achieve. Personal protective equipment including particulate respirators provides additional benefit when administrative and environmental controls cannot assure protection.

Keyword

Tuberculosis; Infection Control; Environment, Controlled; Ventilation; Personal Protective Equipment

MeSH Terms

Delivery of Health Care
Environment, Controlled
Filtration
Humans
Infection Control*
Personal Protective Equipment
Tuberculosis*
Ventilation
Ventilators, Mechanical

Reference

1. Ehrenkranz NJ, Kicklighter JL. Tuberculosis outbreak in a general hospital: evidence for airborne spread of infection. Ann Intern Med. 1972; 77:377–382.

2. Mohle-Boetani JC, Miguelino V, Dewsnup DH, Desmond E, Horowitz E, Waterman SH, et al. Tuberculosis outbreak in a housing unit for human immunodeficiency virus-infected patients in a correctional facility: transmission risk factors and effective outbreak control. Clin Infect Dis. 2002; 34:668–676.

3. Curtis AB, Ridzon R, Novick LF, Driscoll J, Blair D, Oxtoby M, et al. Analysis of Mycobacterium tuberculosis transmission patterns in a homeless shelter outbreak. Int J Tuberc Lung Dis. 2000; 4:308–313.

4. Edlin BR, Tokars JI, Grieco MH, Crawford JT, Williams J, Sordillo EM, et al. An outbreak of multidrug-resistant tuberculosis among hospitalized patients with the acquired immunodeficiency syndrome. N Engl J Med. 1992; 326:1514–1521.

5. Sacks LV, Pendle S, Orlovic D, Blumberg L, Constantinou C. A comparison of outbreak- and nonoutbreak-related multidrug-resistant tuberculosis among human immunodeficiency virus-infected patients in a South African hospital. Clin Infect Dis. 1999; 29:96–101.

6. World Health Organization. WHO policy on TB infection control in health-care facilities, congregate settings and households. Geneva: World Health Organization;2009.

7. Jensen PA, Lambert LA, Iademarco MF, Ridzon R. CDC. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care settings, 2005. MMWR Recomm Rep. 2005; 54:1–141.

8. Basu S, Andrews JR, Poolman EM, Gandhi NR, Shah NS, Moll A, et al. Prevention of nosocomial transmission of extensively drug-resistant tuberculosis in rural South African district hospitals: an epidemiological modelling study. Lancet. 2007; 370:1500–1507.

9. Curry International Tuberculosis Center. Tuberculosis infection control: a practical manual for preventing TB. Oakland: Curry International Tuberculosis Center;2011.

10. Menzies D, Fanning A, Yuan L, FitzGerald JM. Hospital ventilation and risk for tuberculous infection in canadian health care workers. Canadian Collaborative Group in Nosocomial Transmission of TB. Ann Intern Med. 2000; 133:779–789.

11. American Institute of Architects. Guidelines for design and construction of health care facilities. Washington, DC: American Institute of Architects;2006.

12. Escombe AR, Oeser CC, Gilman RH, Navincopa M, Ticona E, Pan W, et al. Natural ventilation for the prevention of airborne contagion. PLoS Med. 2007; 4:e68.

13. American Society of Heating, Refrigerating and Air-Conditioning Engineers. 2003 ASHRAE handbook: HVAC applications. Atlanta: American Society of Heating, Refrigerating and Air-Conditioning Engineers;2003.

14. National hospitalization (isolation) wards and operating management [Internet]. Sejong: Korea Ministry of Government Legislation;2011. cited 2016 Jun 1. Available from: http://www.law.go.kr/flDownload.do?flSeq=9689277.

15. Riley RL, Knight M, Middlebrook G. Ultraviolet susceptibility of BCG and virulent tubercle bacilli. Am Rev Respir Dis. 1976; 113:413–418.

16. Escombe AR, Moore DA, Gilman RH, Navincopa M, Ticona E, Mitchell B, et al. Upper-room ultraviolet light and negative air ionization to prevent tuberculosis transmission. PLoS Med. 2009; 6:e43.

17. Mphaphlele M, Dharmadhikari AS, Jensen PA, Rudnick SN, van Reenen TH, Pagano MA, et al. Institutional Tuberculosis Transmission. Controlled trial of upper room ultraviolet air disinfection: a basis for new dosing guidelines. Am J Respir Crit Care Med. 2015; 192:477–484.

18. Department of Health and Human Services, Centers for Disease Control and Prevention. National Institute for Occupational Safety and Health. Environmental control for tuberculosis: basic upper-room ultraviolet germicidal irradiation guidelines for healthcare settings. DHHS (NIOSH) Publication No. 2009-105. Atlanta: Department of Health and Human Services, Centers for Disease Control and Prevention;2009.

19. Brubacher J, Hoffman RS. Hazards of ultraviolet lighting used for tuberculosis control. Chest. 1996; 109:582–583.

20. Talbot EA, Jensen P, Moffat HJ, Wells CD. Occupational risk from ultraviolet germicidal irradiation (UVGI) lamps. Int J Tuberc Lung Dis. 2002; 6:738–741.

21. National Institute for Occupational Safety and Health. Respirator trusted-source information. Section 3: ancillary respirator information. Washington, DC: National Institute for Occupational Safety and Health;2015.

22. Shaffer RE, Janssen LL. Selecting models for a respiratory protection program: what can we learn from the scientific literature? Am J Infect Control. 2015; 43:127–132.

23. Fennelly KP. Personal respiratory protection against Mycobacterium tuberculosis. Clin Chest Med. 1997; 18:1–17.

24. Mehta AC, Prakash UB, Garland R, Haponik E, Moses L, Schaffner W, et al. American College of Chest Physicians and American Association for Bronchology [corrected] consensus statement: prevention of flexible bronchoscopy-associated infection. Chest. 2005; 128:1742–1755.

25. Occupational Safety and Health Administration. Personal protective equipment. US Department of Labor Regulations: OSHA 3151-12R. Washington, DC: Occupational Safety and Health Administration;2003.

26. Lam SC, Lee JK, Yau SY, Charm CY. Sensitivity and specificity of the user-seal-check in determining the fit of N95 respirators. J Hosp Infect. 2011; 77:252–256.

27. Yu Y, Jiang L, Zhuang Z, Liu Y, Wang X, Liu J, et al. Fitting characteristics of N95 filtering-facepiece respirators used widely in China. PLoS One. 2014; 9:e85299.

28. Lee K, Slavcev A, Nicas M. Respiratory protection against Mycobacterium tuberculosis: quantitative fit test outcomes for five type N95 filtering-facepiece respirators. J Occup Environ Hyg. 2004; 1:22–28.

29. McMahon E, Wada K, Dufresne A. Implementing fit testing for N95 filtering facepiece respirators: practical information from a large cohort of hospital workers. Am J Infect Control. 2008; 36:298–300.

30. Coffey CC, Lawrence RB, Campbell DL, Zhuang Z, Calvert CA, Jensen PA. Fitting characteristics of eighteen N95 filtering-facepiece respirators. J Occup Environ Hyg. 2004; 1:262–271.

31. Clayton M, Vaughan N. Fit for purpose? The role of fit testing in respiratory protection. Ann Occup Hyg. 2005; 49:545–548.

32. Danyluk Q, Hon CY, Neudorf M, Yassi A, Bryce E, Janssen B, et al. Health care workers and respiratory protection: is the user seal check a surrogate for respirator fit-testing? J Occup Environ Hyg. 2011; 8:267–270.

33. Lam SC, Lui AK, Lee LY, Lee JK, Wong KF, Lee CN. Evaluation of the user seal check on gross leakage detection of 3 different designs of N95 filtering facepiece respirators. Am J Infect Control. 2016; 44:579–586.

34. Or P, Chung J, Wong T. Does training in performing a fit check enhance N95 respirator efficacy? Workplace Health Saf. 2012; 60:511–515.