14.7 Patients’ homes

In settings where DR-TB (and HIV) is highly prevalent, systematic TB IC evaluations on patients’ homes are recommended.

TB IC at patients’ homes follows the same principles and measures as in healthcare facilities. Administrative, environmental and personal measures should be followed at least until patient’s smear is negative, ideally until culture conversion.

Administrative measures
– Assess the risk of TB transmission: gather information on the number of people that live in the house, number of rooms, etc.
– Screen contacts for TB.
– Children under 5 should spend as little time as possible in the same spaces as culture-positive patient (although the risk to the child is greatly reduced once a patient starts an effective regimen). The mother should use a surgical mask while taking care of the child until she becomes smear-negative.
– Offer education on TB transmission, airborne precautions (cough etiquette, masks), clinical symptoms and waste management of sputum containers or tissues (do not empty the container; throw it in the latrines or enclose it hermetically in plastic bags and discard in the normal waste).

Environmental measures
– Ideally, the patient should sleep in a separated room, with door closed off to the rest of the house.
– Common spaces should be well ventilated (often done by keeping windows open at all times).
– The patient should be encouraged to spend time outside in a shaded area if weather permits.

Personal protective measures
– If smear-positive or not responding to the regimen, the patient should wear surgical masks when in contact with persons in areas poorly ventilated. Once smear-negative, the patient can be considered non-infectious and no longer needs to wear masks.
– Any person attending to the patient in enclosed spaces should wear a respirator. A fit test should be performed, and the person should be educated on the proper use of respirators. Once the patient is smear-negative, respirators are no longer necessary.