Evidence for the Use of Triage, Respiratory Isolation, and Effective Treatment to Reduce the Transmission of Mycobacterium Tuberculosis in Healthcare Settings: A Systematic Review.

Aaron S Karat,Katherine L Fielding,Meghann Gregg,David A J Moore,Rebecca C Harris,Jayne Ellis,Indira Govender,Hannah E Barton,Maria Calderon,Jane Falconer,Mpho Tlali

doi:10.1093/cid/ciaa720

Abstract

Evidence is limited for infection prevention and control (IPC) measures reducing Mycobacterium tuberculosis (MTB) transmission in health facilities. This systematic review, 1 of 7 commissioned by the World Health Organization to inform the 2019 update of global tuberculosis (TB) IPC guidelines, asked: do triage and/or isolation and/or effective treatment of TB disease reduce MTB transmission in healthcare settings?Of 25 included articles, 19 reported latent TB infection (LTBI) incidence in healthcare workers (HCWs; absolute risk reductions 1%–21%); 5 reported TB disease incidence in HCWs (no/slight [high TB burden] or moderate [low burden] reduction) and 2 in human immunodeficiency virus-positive in-patients (6%–29% reduction). In total, 23/25 studies implemented multiple IPC measures; effects of individual measures could not be disaggregated.Packages of IPC measures appeared to reduce MTB transmission, but evidence for effectiveness of triage, isolation, or effective treatment, alone or in combination, was indirect and low quality. Harmonizing study designs and reporting frameworks will permit formal data syntheses and facilitate policy making.

Highlights

IntroductionTuberculosis (TB) is the leading infectious cause of death worldwide.[1,2] Health care workers (HCWs) are at higher risk of TB than the general population, likely because of exposure in health facilities.[3,4,5,6,7] Infection prevention and control (IPC) measures to reduce Mycobacterium tuberculosis (MTB) transmission in health care settings are considered under three categories: environmental controls (e.g., mechanical ventilation); personal protection (e.g., using respirators); and administrative controls (e.g., coordinating efforts between governmental health departments).[8] Evidence is limited, for the effectiveness of individual infection prevention and control (IPC) measures in reducing MTB transmission, and guidelines have been written based heavily on expert opinion.9–
Tuberculosis (TB) is the leading infectious cause of death worldwide.[1,2] Health care workers (HCWs) are at higher risk of TB than the general population, likely because of exposure in health facilities.[3,4,5,6,7] Infection prevention and control (IPC) measures to reduce Mycobacterium tuberculosis (MTB) transmission in health care settings are considered under three categories: environmental controls; personal protection; and administrative controls.[8]
Six TB infection prevention and control (IPC) guidelines were reviewed for possible primary research articles (Supplementary 3)

Summary

Introduction

Tuberculosis (TB) is the leading infectious cause of death worldwide.[1,2] Health care workers (HCWs) are at higher risk of TB than the general population, likely because of exposure in health facilities.[3,4,5,6,7] Infection prevention and control (IPC) measures to reduce Mycobacterium tuberculosis (MTB) transmission in health care settings are considered under three categories: environmental controls (e.g., mechanical ventilation); personal protection (e.g., using respirators); and administrative controls (e.g., coordinating efforts between governmental health departments).[8] Evidence is limited, for the effectiveness of individual IPC measures in reducing MTB transmission, and guidelines have been written based heavily on expert opinion.9–. The guidelines contain recommendations for practice based on consideration of a wide range of evidence and should be the primary resource for implementation; this article looks more closely at how these interventions have been studied and discusses the implications for future TB IPC research

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Discussion

Conclusion