Infection Control and Prevention
Infection Control Principles and Practices for Local Public Health
Agencies
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Tuberculosis
Preventing Transmission
Mycobacterium tuberculosis is transmitted in airborne
particles called droplet nuclei that are expelled when persons with
pulmonary or laryngeal TB cough, sneeze, shout, or sing. The tiny
infectious particles can be carried by air currents throughout a room or
building. Tuberculosis is not transmitted by direct contact or via contaminated
surfaces or items.
Local public health agency personnel are potentially exposed to TB
during case management activities such as directly observed therapy or
when persons with unrecognized pulmonary TB are present in the agency
facility. Local public health agencies should establish TB
infection control programs that include administrative and respiratory
protection measures to help prevent TB transmission among staff and
visitors. Environmental engineering of air handling systems to create
airborne infection isolation rooms is used to house hospital TB patients
but is usually not available in public health settings.
Administrative measures include assigning a designated staff person
responsibility for TB infection control, conducting a TB risk assessment
for the facility, writing a control plan, and implementing effective
work practices for detecting and managing clients entering the facility
with signs and symptoms that may indicate active TB disease.
Respiratory protection measures that include use of N-95 respirators
are also necessary for public health personnel with exposure to active
TB cases. A respiratory protection program should be established to
provide staff training, fit-testing, and medical evaluation for
respirator use.
The following general practices should be in place in all local
public health agency settings. More specific information can be found in
the links below.
Basic measures to prevent transmission of TB in local public
health agencies:
- Establish policies that minimize or eliminate the presence of
suspect or known TB cases in local public health agency facilities.
- Establish cough etiquette practices among staff and clients.
Provide tissue, hand hygiene products, and waste containers in
common areas such as waiting rooms so persons with respiratory
symptoms can contain coughing and sneezing. Have surgical masks
available for persons to wear while waiting, and place persons with
respiratory symptoms in an examination room or area away from others
as soon as possible. Display posters and other educational material
to encourage cough etiquette practices. Consider use of barriers
such as Plexiglas “sneeze guards” for reception areas.
- Implement a TB screening protocol for clients presenting with
cough or other respiratory symptoms. A screening tool should
determine the presence of any one of the following: duration of
cough for more than three weeks, blood in sputum, night sweats,
unexplained weight loss, and history of TB disease or TB exposure.
- If screening results increase suspicion of TB, ask the client to
wear a surgical mask and place in a private examination room or
remove from others immediately. All staff members entering the
examination room should wear a NIOSH approved fit-tested N-95
respirator. Once the room is empty, it should remain unoccupied for
a period of time to clear the air of airborne TB particles (see
Table 1 in the CDC Guidelines for Preventing Transmission of TB for
required times).
- Do not perform aerosol inducing procedures or sputum collections
in public health facilities, as negative pressure room are usually
not available to contain airborne particles generated by these
procedures.
- Staff doing home visits for infectious TB patients should wear
NIOSH approved fit-tested N-95 filtering face pieces or powered
air-purifying respirators while in the shared air space of the
patient.
More Resources
For Infection Control Information
Gwen Borlaug Infection Control Epidemiologist
WI Division of Public Health
Bureau of Communicable Diseases
608-267-7711 Phone
608-261-4976 Fax
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Last Revised: November 04, 2008 |
