Tuberculosis transmission and control
- Kimon C Zachary, MD
Kimon C Zachary, MD
- Assistant Professor of Medicine
- Harvard Medical School
The transmission of tuberculosis (TB) in healthcare facilities is an important public health concern; careful infection control measures are required to reduce healthcare-associated transmission [1,2].
Issues related to control of TB transmission will be reviewed here. Other issues related to TB are discussed in detail separately. (See related topics.)
Person-to-person transmission of tuberculosis (TB) occurs via inhalation of droplet nuclei (airborne particles 1 to 5 microns in diameter). Coughing and singing facilitate formation of droplet nuclei [3-7]. (See "Natural history, microbiology, and pathogenesis of tuberculosis".)
Factors associated with risk for TB transmission via droplet nuclei include [8,9]:
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- Cowan JF, Chandler AS, Kracen E, et al. Clinical Impact and Cost-effectiveness of Xpert MTB/RIF Testing in Hospitalized Patients With Presumptive Pulmonary Tuberculosis in the United States. Clin Infect Dis 2017; 64:482.
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- US Food and Drug Administration. New data shows test can help physicians remove patients with suspected TB from isolation earlier. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm434226.htm (Accessed on February 19, 2015).
- Revised Device Labeling for the Cepheid Xpert MTB/RIF Assay for Detecting Mycobacterium tuberculosis. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6407a8.htm?s_cid=mm6407a8_e (Accessed on February 26, 2015).
- Luetkemeyer AF, Firnhaber C, Kendall MA, et al. Evaluation of Xpert MTB/RIF Versus AFB Smear and Culture to Identify Pulmonary Tuberculosis in Patients With Suspected Tuberculosis From Low and Higher Prevalence Settings. Clin Infect Dis 2016; 62:1081.
- Campos M, Quartin A, Mendes E, et al. Feasibility of shortening respiratory isolation with a single sputum nucleic acid amplification test. Am J Respir Crit Care Med 2008; 178:300.
- Fløe A, Hilberg O, Thomsen VØ, et al. Shortening Isolation of Patients With Suspected Tuberculosis by Using Polymerase Chain Reaction Analysis: A Nationwide Cross-sectional Study. Clin Infect Dis 2015; 61:1365.
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- TB TRANSMISSION
- COMPONENTS OF TB INFECTION CONTROL
- Airborne infection isolation
- Use of masks
- - Healthcare workers
- - Patients
- - Visitors
- Contact investigation
- Assessing compliance
- CLINICAL APPROACH
- Assessing risk for TB
- Diagnostic evaluation
- Clinical triaging
- - Outpatient management
- - Inpatient management
- Initiating airborne precautions
- Discontinuing airborne precautions
- Discharge planning
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS