[Table of Contents]

Volume: 22S1 • April 1996

Guidelines for Preventing the Transmission of Tuberculosis in Canadian Health Care Facilities and Other Institutional Settings

I. INTRODUCTION

This document has been prepared to assist Canadian health care facilities and health care workers (HCWs) to develop and implement effective programs within their institutions to minimize transmission of the organisms that cause tuberculosis (TB). Tuberculosis is the name given to the disease caused by Mycobacterium tuberculosis, M. bovis (except the disease caused by the strain of M. bovis that is used in the Bacille Calmette-Guérin (BCG) vaccine) and M. africanum.

Patients with pulmonary, laryngeal, and, rarely, other forms of TB who are cared for in health care settings can transmit infection to other patients and HCWs. Transmission of TB infection occurs almost exclusively from patients with acid-fast bacilli (AFB), smear-positive pulmonary or laryngeal TB. The greatest risk for transmission of TB occurs during the time prior to diagnosis and institution of measures to prevent transmission, including effective therapy and isolation precautions.

Recent reports from the United States have documented outbreaks of TB, including outbreaks of multi drug-resistant TB (MDR-TB), in health care facilities. These reports have also documented the failure of health care facilities to implement appropriate TB control measures^(1-7). These findings have heightened concern about the nosocomial transmission of TB and have focused efforts on optimizing methods to minimize transmission.

In Canada, TB occurs primarily in well-defined population subgroups, including Aboriginal Canadians, the elderly, and foreign-born individuals. In addition, immunocompromised persons, such as those with human immunodeficiency virus (HIV) infection and diabetes mellitus, are at increased risk for developing active TB if they are infected with M. tuberculosis. Because HCWs may be in frequent contact with individuals in these risk groups, the risk of transmission of TB to HCWs exists.

These guidelines address issues of program design and administration, risk assessment, identification, isolation, and management of patients with infectious TB, engineering controls, follow-up of exposed patients and HCWs, and education and surveillance programs for HCWs.

The proposed recommendations reflect consensus based on current information and experience. Adequate data to define risks or evaluate the efficacy of interventions are limited. Further study regarding the acquisition and prevention of transmission of TB in health care facilities is required. As information becomes available, the recommendations in these guidelines may require modification.

Effective TB management requires ongoing efforts to identify persons with infectious disease. An integral component of all health care facility TB management programs is the reporting of individuals with active TB to the appropriate provincial or territorial authority. Such reporting is mandated by provincial and territorial reporting legislation.

In this document, the term health care facility refers to a variety of health care settings, including hospitals, ambulatory care facilities, outpatient clinics, home health care settings, long-term care or residential facilities and medical areas of correctional facilities. The term patient is used to identify the individual (patient, client or resident) who receives health care in these settings. The term health care workers (HCWs) refers to all paid and unpaid persons working in the health care facility (including health care facility staff, physicians, volunteers and students).

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