Abstract
Globally, tuberculosis (TB) is a leading cause of death from a single infectious agent. Healthcare workers (HCWs) are at increased risk of hospital-acquired TB infection due to persistent exposure to Mycobacterium tuberculosis (Mtb) in healthcare settings. The World Health Organization (WHO) has developed an international system of infection prevention and control (IPC) interventions to interrupt the cycle of nosocomial TB transmission. The guidelines on TB IPC have proposed a comprehensive hierarchy of three core practices, comprising: administrative controls, environmental controls, and personal respiratory protection. However, the implementation of most recommendations goes beyond minimal physical and organisational requirements and thus cannot be appropriately introduced in resource-constrained settings and areas of high TB incidence. In many low- and middle-income countries (LMICs) the lack of knowledge, expertise and practice on TB IPC is a major barrier to the implementation of essential interventions. HCWs often underestimate the risk of airborne Mtb dissemination during tidal breathing. The lack of required expertise and funding to design, install and maintain the environmental control systems can lead to inadequate dilution of infectious particles in the air, and in turn, increase the risk of TB dissemination. Insufficient supply of particulate respirators and lack of direction on the re-use of respiratory protection is associated with unsafe working practices and increased risk of TB transmission between patients and HCWs. Delayed diagnosis and initiation of treatment are commonly influenced by the effectiveness of healthcare systems to identify TB patients, and the availability of rapid molecular diagnostic tools. Failure to recognise resistance to first-line drugs contributes to the emergence of drug-resistant Mtb strains, including multidrug-resistant and extensively drug-resistant Mtb. Future guideline development must consider the social, economic, cultural and climatic conditions to ensure that recommended control measures can be implemented in not only high-income countries, but more importantly low-income, high TB burden settings. Urgent action and more ambitious investments are needed at both regional and national levels to get back on track to reach the global TB targets, especially in the context of the COVID-19 pandemic.
Highlights
Tuberculosis (TB) remains one of the leading causes of preventable morbidity and mortality worldwide with approximately 10 million new cases and 1.4 million deaths in 2019 [1].From 2020, the Coronavirus disease 2019 (COVID19) pandemic has contributed to severe disruption to essential TB care, services, and infectious disease epidemiology
Administrative controls Administrative controls are the most important level of infection prevention and control (IPC) hierarchy, and includes triage and isolation of patients with suspected or confirmed TB infection, prompt diagnosis and initiation of treatment, promotion of respiratory hygiene and management of healthcare personnel [3, Table 1 Summary of IPC interventions based on a three-level hierarchy of controls
According to a study conducted in a large academic hospital in Cape Town, South Africa, a significant and high proportion of Healthcare worker (HCW) had a poor level of knowledge and practice regarding TB IPC [8]
Summary
Tuberculosis (TB) remains one of the leading causes of preventable morbidity and mortality worldwide with approximately 10 million new cases (estimated range8.9–11 million) and 1.4 million deaths (estimated range 1.2–1.5 million) in 2019 [1].From 2020, the Coronavirus disease 2019 (COVID19) pandemic has contributed to severe disruption to essential TB care, services, and infectious disease epidemiology. Administrative controls Administrative controls are the most important level of IPC hierarchy, and includes triage and isolation of patients with suspected or confirmed TB infection, prompt diagnosis and initiation of treatment, promotion of respiratory hygiene and management of healthcare personnel (i.e. education and training of HCWs) [3, Table 1 Summary of IPC interventions based on a three-level hierarchy of controls
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