14.2 Implementation of TB IC strategies

There is a trio of infection control levels, which include (1) administrative, (2) environmental and (3) personal protective controls5. The implementation of these measures requires a dedicated staff and an IC plan.

14.2.1 Infection control practitioner

A person should be clearly identified and designated as responsible for TB IC. This person should have the support and authority to conduct, apply and evaluate TB IC policies. This person in some settings is also known as IC officer.

14.2.2 Infection control committee

The IC practitioner would evaluate the need to create an infection control committee (ICC). The ICC might include doctors, nurses, laboratory technicians, logisticians and administration staff (including representation from the maintenance and housekeeping services). According to the context and degree of risk, experts in IC may be needed.

14.2.3 Infection control plan

All facilities should have a detailed written IC plan that is at least annually updated and distributed to healthcare staff.
A simplified version of the plan must be accessible to all healthcare workers including staff not directly involved in TB patients’ management, such as cleaners, kitchen staff, etc.

The first step in developing an IC plan is assessing the health care facility’s risk for TB transmission6. This should be performed by the IC practitioner. The plan must be specific to each facility.
An example of risk assessment tool is given in Appendix 16.

The IC plan should include the different types of measures—administrative, environmental and personal. Information on specific precautions and procedures for high-risk areas should be detailed.

It is recommended to draw a floor plan of the facility with the different areas, including the patient flow and identifying areas of high risk.

Listed below from highest to lowest level of risk:

Highest risk
• Smear-positive inpatient unit
• Diagnosis department
• Culture/drug susceptibility test (DST) and sputum smear preparation area (laboratory)
• Sputum collection area
• Radiology department
• Waiting area

Limited risk
• Children inpatient ward
• Extrapulmonary TB (EPTB) and smear-negative unit
• Sputum reception and smear reading area (laboratory)
• Waste management area

Lowest risk (non-TB zone)
• Kitchen area
• Administration