Volume: 22S1 • April 1996

Guidelines for Preventing the Transmission of Tuberculosis in Canadian Health Care Facilities and Other Institutional Settings

Table of Contents

I. INTRODUCTION

II. EPIDEMIOLOGY OF TB IN CANADA
Geographic Differences
Risk Groups
Drug-Resistant TB
HIV and TB
Risk of Nosocomial Transmission of TB

III. TB TRANSMISSION
Risk of Transmission
The patient with active infection
The environment
The susceptibility of the exposed person

IV. TB MANAGEMENT PROGRAM
General

A. Administrative Responsibilities Related to the TB Management Program
Surveillance for active TB

B. Assessment and Classification of Risk of TB Transmission in the Facility
Determining health care facility risk
First stage
High-risk facility
Low-risk facility
Second stage
High-risk facility
Low-risk facility
Determining activity risk

C. HCW TB Screening and Surveillance Programs

1. Pre-Placement and Baseline Screening
   Screening to be performed at pre-placement or verification of current TB infection status
   Rationale for two-step testing: the boosting phenomena
   Performing a two-step TST
   Response to individuals w ith positive TST results

2. Ongoing Surveillance Programs for HCWs
   Determining the frequency of ongoing surveillance programs for HCWs
   Cluster events or unexpectedly high TST conversion rates
   Record keeping

1. Programs for the Early Identification and Evaluation of Persons with Suspected Infectious TB

2. Isolation of Persons w ith Suspected or Confirmed Infectious TB
   Additional considerations
   Isolation precautions for patients w ith suspected or confirmed infectious TB receiving care in ambulatory care areas or emergency rooms
   Isolation precautions for individuals with suspected or confirmed infectious TB undergoing procedures either as ambulatory or admitted patients
   Isolation precautions for patients w ith suspected or confirmed infectious TB admitted to acute care facilities
   Isolation precautions for individuals w ith suspected or confirmed infectious TB who are living in long-term care facilities
   Discontinuation of isolation precautions

3. Notification of Infection Control Personnel

4. Confirmation of Diagnosis Laboratory specimens
   Laboratory results

5. Initiation of Treatment

6. Notification of Public Health Authorities

7. Identification, Assessment and Management of Contacts Identification of contacts
   Assessment of contacts
   Management of contacts with a documented TST conversion or symptoms suggestive of active TB
   Provision of isoniazid (INH) preventive therapy

8. Evaluation of TB Exposure Events

F. Personal Respiratory Protection (Masks)
Types of Masks
Facial Fit
Wearer Acceptance
Recommended Use of Masks

G. Educational and Counselling Programs for HCWs
Educational Programs
Education of HCWs New to the Facility
Ongoing Education of HCWs
Counselling Programs
Periodic Updates of Individual and Group Health Status

H. Liaison w ith Public Health Authorities

I. Program Review and Evaluation

J. Action Summary
TB Management Program
Personnel with Expertise in Managing Individuals with Active TB
Ventilation
Number and Type of Isolation Rooms
Masks
HCW Screening and Surveillance

V. TB CONTROL IN RESIDENTIAL SETTINGS
Correctional Facilities
Hostels and Hospices
Long-term Care Facilities

VI. LABORATORIES
Laboratory Identification of M. tuberculosis
Operational and Physical Requirements

Appendix A-Background Information on Hospital Risk Assessment
Appendix B-Tuberculin Skin Testing
Appendix C-Guidelines for the Use of Isoniazid (INH) Preventive Therapy
Appendix D-Treatment Guidelines for Active TB
Appendix E-Health Care Workers Surveillance Report Form
Appendix F-Air Changes Per Hour and Time in Minutes Required for Removal Efficiencies of 90%, 99% or 99.9% of Airborne Contaminants

REFERENCES

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