Canadian Tuberculosis Standards

Canadian Tuberculosis Standards

7th Edition

Chapter 15: Prevention and Control of Tuberculosis Transmission in Health Care and Other Settings

To promote and protect the health of Canadians through leadership, partnership, innovation and action in public health.

-- Public Health Agency of Canada

Canadian Tuberculosis Standard, 7th edition

?galement disponible en fran?ais sous le titre : Normes canadiennes pour la lutte antituberculeuse, 7i?me ?dition

To obtain copy of the report, send your request to: Centre for Communicable Diseases and Infection Control Public Health Agency of Canada E-mail: ccdic-clmti@phac-aspc.gc.ca

This publication can be made available in alternative formats upon request

? Her Majesty the Queen in Right of Canada, 2014

This publication may be reproduced for personal or internal use only without permission provided the source is fully acknowledged. However, multiple copy reproduction of this publication in whole or in part for purposes of resale or redistribution requires the prior written permission from the Minister of Public Works and Government Services Canada, Ottawa, Ontario K1A 0S5 or copyright.droitdauteur@pwgsc.gc.ca

PDF Cat.: HP40-18/2014E-PDF ISBN: 978-1-100-23171-6 Pub.: 140210

1 | CANADIAN TUBERCULOSIS STANDARDS ? 7TH EDITION

TABLE OF CONTENTS

Prevention and Control of Tuberculosis Transmission in Health Care and Other Settings ...........3 Key Messages/Points .................................................................................................................................................. 3 Major Recommendations............................................................................................................................................3 Introduction and General Principles ........................................................................................................................ 4

Determinants of Transmission of Mycobacterium Tuberculosis.......................................................5 Respiratory (Pulmonary or Laryngeal) TB Disease..........................................................................6 Number of Patients with Respiratory TB Disease ............................................................................6 HIV Infection .....................................................................................................................................7 Delayed Diagnosis............................................................................................................................7 Incorrect, Ineffective or No Therapy .................................................................................................7 Inadequate Ventilation......................................................................................................................7 Duration of Exposure and Proximity to Infectious Patient ................................................................7 Overcrowding ...................................................................................................................................7 Risk Classification ........................................................................................................................................................ 8 Health Care Settings ........................................................................................................................8 HCW Activities ..................................................................................................................................8 Laboratory Personnel Handling M. Tuberculosis .............................................................................9 Prevention and Control of Transmission of M. Tuberculosis ..........................................................................10 Administrative Controls within Hospitals ........................................................................................10 Tuberculosis Management Program ..............................................................................................11 Risk Assessment ............................................................................................................................11 Education of HCWs ........................................................................................................................12 Identification of Patients with Respiratory TB disease Within Hospitals .......................................13 Airborne Precautions for Patients with Suspected or Confirmed Respiratory TB Disease............................................................................................14 Isolation considerations for pediatric patients ................................................................................15 Transport of Patients with Suspected or Confirmed Respiratory TB Disease ..............................16 Preventing Patient-to-Patient Transmission of M. Tuberculosis Within Hospitals ........................17 Discontinuation of Airborne Precautions ........................................................................................17 Environmental (Engineering) Controls within Hospitals...................................................................................21 Ventilation Guidelines .....................................................................................................................21 Personal Protection Controls Within Hospitals...................................................................................................26 Respiratory Protection Program .....................................................................................................26 Screening for LTBI as Part of Infection Prevention and Control in Hospitals................................28 Infection Prevention and Control of M. Tuberculosis in Specific Units and Populations Within Hospitals ..........................................................................................................................32 Specific Units ..................................................................................................................................32

2 | CANADIAN TUBERCULOSIS STANDARDS ? 7TH EDITION

Prevention of Transmission of M. Tuberculosis Within Other Health Care Settings ................................33 Long-term Care Facilities ...............................................................................................................33 Ambulatory Care/Outpatient Clinics ...............................................................................................34 Paramedics and Other Emergency Medical Services ....................................................................34 Remote and Isolated Health Care Settings ....................................................................................35 Home Care Settings .......................................................................................................................36

Prevention of Transmission of M. Tuberculosis Within Residential and Community Care Settings...........................................................................................................36

Adult Day Care Centres..................................................................................................................37 Homeless Shelters and Drop-in Centres........................................................................................37 Addiction Treatment Centres..........................................................................................................38 Prevention of Transmission of M. Tuberculosis Within Correctional Facilities..........................................38 TB Control Program for Correctional Facilities...............................................................................39 References .............................................................................................................................................44

3 | CANADIAN TUBERCULOSIS STANDARDS ? 7TH EDITION

CHAPTER 15

PREVENTION AND CONTROL OF TUBERCULOSIS TRANSMISSION IN HEALTH CARE AND OTHER SETTINGS

Toju Ogunremi, BSc, MSc Dick Menzies MD, MSc John Embil, MD, FCAP

KEY MESSAGES/POINTS

? The scope of this chapter includes hospitals; other health care settings; and residential and community care settings.

? Health care organizations and individual health care workers (HCWs) have a shared responsibility to apply effective tuberculosis infection prevention and control measures.

? The risk of health care associated transmission of M. tuberculosis varies with the type of setting, HCW occupational group, patient care activity, patient/resident/client population and the effectiveness of tuberculosis (TB) infection prevention and control measures.

? The most important contributors to health care associated transmission of M. tuberculosis are patients with unrecognized, respiratory TB disease. Hence, the most important element of any TB management program is rapid diagnosis, isolation and start of effective therapy for these patients.

? Remote and isolated health care settings in which at-risk populations are cared for should have access to resources to facilitate implementation of essential administrative, environmental and personal protective controls.

MAJOR RECOMMENDATIONS

? All health care settings should have a TB management or infection prevention and control program supported at the highest administrative level. This involves a hierarchical approach to infection prevention and control measures categorized as administrative, environmental and personal protection controls.

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