[Table of Contents]

Volume: 22S1 • April 1996

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

IV. TB MANAGEMENT PROGRAM

General

The TB Management Program should include the following interrelated components:

A. Administrative Responsibilities Related to the TB Management Program

B. Assessment and Classification of Risk of TB Transmission in the Facility

C. HCW TB Screening and Surveillance Programs

D. Strategies for Managing Suspected or Confirmed Infectious TB

E. Engineering Controls to Minimize TB Transmission

F. Personal Respiratory Protection (NOTE: For the purposes of this document, devices for personal respiratory protection are called "masks")

G. Educational and Counselling Programs for HCWs

H. Liaison with Public Health Authorities

I. Program Review and Evaluation

All health care facilities should develop and implement facility-specific policies and procedures for each component. A summary of these components is found in Section IV.J.

Health care facilities cannot act alone. Health care facilities should establish policies and procedures to facilitate collaborative efforts with local public health authorities and other health care facilities in the region in order to develop a comprehensive regional TB program.

A. Administrative Responsibilities Related to the TB Management Program

Specific personnel within the health care facility should have responsibility for the program. If a new committee is established, membership should be determined by the needs of the facility and should include those persons with day-to-day responsibility for infection control and employee health. There should also be representation from senior administration, laboratory, nursing, medicine, other health disciplines (e.g., respiratory technology) and public health. Additional members may be added from other employee groups (e.g., central supply, housekeeping, laundry, pharmacy, physical plant and maintenance) (38) .

The designated personnel responsible for the TB management program should:

• develop policies and procedures to support the TB management program, review these at least annually and revise them as needed to reflect facility requirements, new information and changes in guidelines (see Section IV.I) (all health care facilities, including those which are assessed to be low risk for TB transmission, should have a TB management program);
• establish protocols to ensure coordination and effective communication among different individuals and groups involved in the TB management program;
• conduct annually and update, as required, an assessment of the risk of transmission of TB within the health care facility (see Section IV.B);
• ensure that information is disseminated to HCWs within the facility regarding the risk of transmission of TB;
• determine the facility requirements for isolation rooms, engineering control measures (e.g., ventilation, ultra-violet lights), etc; and
• liaise with regional and public health authorities and staff from other health care facilities in the region to assess regional needs and to establish an integrated TB management program (e.g., shared isolation rooms for the region).

The TB Management Program should identify mechanisms to provide ongoing surveillance to recognize individuals with active TB who receive care and treatment within the health care facility. Personnel designated as responsible for the TB Management Program should:

• be notified by the laboratory staff of any AFB-positive smears or cultures that grow M. tuberculosis;
• monitor the use of TB drugs by the pharmacy;
• review patient transfers between facilities when a patient has suspected or confirmed infectious TB;
• review the results of the HCW screening program; and
• review the records of individuals newly diagnosed with active TB to determine if TB was acquired within the health care facility.

[Previous] [Table of Contents] [Next]