14.1 Introduction


The largest source of M. tuberculosis transmission is the contagious patients with respiratory tuberculosis not yet diagnosed and put on treatment. Therefore, tuberculosis infection control (TB IC) relies, above all, on:
– Early diagnosis (including in clinics and any non-tuberculosis medical wards, whereby active case finding through cough surveillance of all admissions should avoid days or weeks of transmission from unsuspected TB cases);
AND
– Prompt implementation of effective treatment. With effective treatment, contagiousness decreases even after a few days and may be considered nil after 2 to 3 weeks of treatment1,2,3,4. It is essential the treatment is “effective,” as multidrug-resistant TB (MDR-TB) patients that are placed on first-line anti-TB drugs are likely to remain contagious.

However, in health care facilities where TB patients or persons suspected of having TB congregate, additional measures are needed to reduce the risk of transmission between patients, to health care staff and to vulnerable (particularly immunocompromised) patients/visitors5.

TB infection control (IC)1 consists in different strategies for preventing transmission of TB in health care facilities.



Footnotes
Ref Notes
1

This chapter reviews the basic TB IC strategies. More in depth information can be found from the Tuberculosis Coalition for Technical Assistance which has published a framework  and developed a website (http://www.tbcta.org/Library ) that provides a comprehensive set of examples.