Prevention

Monitoring and evaluation are key factors in the success of a TB IPC intervention because they allow progress to be reviewed and plans to be adapted. In contrast to other TB programme interventions, which focus on patient coverage and outcome, much of the monitoring of TB IPC relies heavily on process indicators relating to the enhancement of facilities and changes in behaviour and practices. Monitoring and evaluation addresses questions such as: Is an IPC committee in place? Is triage being performed? Is equipment for mechanical ventilation in place? Has training been conducted?

5.1 TB IPC in congregate settings

Respiratory protection should be implemented as a part of a package of TB IPC interventions. However, inappropriate implementation of respiratory protection measures, or reliance on these measures alone, may create a false sense of security and increase the risk of TB (13). The available studies assessing the effectiveness of respiratory protection in reducing the risk of M. tuberculosis transmission are highly heterogeneous. The absolute reduction in TST conversion ranged from 4.3% to 14.8% (13).

Administrative controls are interventions aimed at reducing exposure and thus the transmission of M. tuberculosis in health facilities and congregate settings. These controls include triage to identify people with presumptive TB and then separate them, prompt evaluation for TB, initiation of effective TB treatment, and access to tools for respiratory protection.

1.1 Rationale for TB infection prevention and control

Tuberculosis (TB) continues to be a major public health concern and one of the leading causes of death from a single infectious microorganism at the global level (1). Although recent decades have witnessed increased efforts in the fight to end TB, there are still fundamental systemic gaps, particularly in resource-constrained settings and places with a high TB burden.

Note: Unless otherwise specified, the definitions listed below apply to the terms as used in this handbook. They may have different meanings in other contexts.

Airborne Mycobacterium tuberculosis transmission: Spread of aerosolized M. tuberculosis caused by the dissemination of infectious respiratory particles when suspended in air over long distances and time.¹

Air changes per hour (ACH): The number of times that the total air volume in a room or space is completely removed and replaced in an hour.