Volume: 22S1 • April 1996
Guidelines for Preventing the Transmission of
Tuberculosis in Canadian Health Care Facilities and
Other Institutional Settings
Table of Contents
I. INTRODUCTION
II. EPIDEMIOLOGY OF TB IN
CANADA
Geographic Differences
Risk Groups
Drug-Resistant TB
HIV and TB
Risk of Nosocomial Transmission of TB
III. TB
TRANSMISSION
Risk of Transmission
The patient with active infection
The environment
The susceptibility of the exposed person
IV. TB MANAGEMENT
PROGRAM
General
A. Administrative Responsibilities Related to the TB
Management Program
Surveillance for active
TB
B. Assessment and
Classification of Risk of TB Transmission in the
Facility
Determining health care
facility risk
First stage
High-risk facility
Low-risk facility
Second stage
High-risk facility
Low-risk facility
Determining activity risk
C. HCW TB Screening and
Surveillance Programs
- Pre-Placement and Baseline Screening
Screening to be performed at pre-placement or
verification of current TB infection status
Rationale for two-step testing: the boosting
phenomena
Performing a two-step TST
Response to individuals w ith positive TST results
- Ongoing Surveillance Programs for HCWs
Determining the frequency of ongoing surveillance
programs for HCWs
Cluster events or unexpectedly high TST conversion
rates
Record keeping
D. Strategies for
Managing Suspected or Confirmed Infectious TB
- Programs for the Early Identification and
Evaluation of Persons with Suspected Infectious TB
- Isolation of Persons w ith Suspected or Confirmed
Infectious TB
Additional considerations
Isolation precautions for patients w ith suspected
or confirmed infectious TB receiving care in
ambulatory care areas or emergency rooms
Isolation precautions for individuals with
suspected or confirmed infectious TB undergoing
procedures either as ambulatory or admitted
patients
Isolation precautions for patients w ith suspected
or confirmed infectious TB admitted to acute care
facilities
Isolation precautions for individuals w ith
suspected or confirmed infectious TB who are living
in long-term care facilities
Discontinuation of isolation precautions
- Notification of Infection Control Personnel
- Confirmation of Diagnosis Laboratory
specimens
Laboratory results
- Initiation of Treatment
- Notification of Public Health Authorities
- Identification, Assessment and Management of
Contacts Identification of contacts
Assessment of contacts
Management of contacts with a documented TST
conversion or symptoms suggestive of active TB
Provision of isoniazid (INH) preventive therapy
- Evaluation of TB Exposure Events
E. Engineering Controls
to Minimize TB Transmission
Ventilation
Rate of air change
Direction of air flow
Air exhaust (outside the building or recycled)
High Efficiency Particulate Air (HEPA) Filtration
Ultraviolet Germicidal Irradiation (UVGI)
Cleaning of Rooms and Equipment
F. Personal Respiratory
Protection (Masks)
Types of Masks
Facial Fit
Wearer Acceptance
Recommended Use of Masks
G. Educational and
Counselling Programs for HCWs
Educational Programs
Education of HCWs New to the Facility
Ongoing Education of HCWs
Counselling Programs
Periodic Updates of Individual and Group Health
Status
H. Liaison w ith Public
Health Authorities
I. Program Review and
Evaluation
J. Action
Summary
TB Management Program
Personnel with Expertise in Managing Individuals with
Active TB
Ventilation
Number and Type of Isolation Rooms
Masks
HCW Screening and Surveillance
V. TB CONTROL IN
RESIDENTIAL SETTINGS
Correctional
Facilities
Hostels and Hospices
Long-term Care Facilities
VI.
LABORATORIES
Laboratory Identification
of M. tuberculosis
Operational and Physical Requirements
Appendix A-Background
Information on Hospital Risk Assessment
Appendix B-Tuberculin
Skin Testing
Appendix C-Guidelines
for the Use of Isoniazid (INH) Preventive
Therapy
Appendix D-Treatment
Guidelines for Active TB
Appendix E-Health Care
Workers Surveillance Report Form
Appendix F-Air Changes
Per Hour and Time in Minutes Required for Removal
Efficiencies of 90%, 99% or 99.9% of Airborne
Contaminants
REFERENCES
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