Administrative, engineering, and personal protective measures for controlling Mycobacterium tuberculosis

Abstract

Multidrug-resistant Mycobacterium tuberculosis (MDRTB) is defined as Mycobacterium tuberculosis (MTB) with resistance to at least isoniazid and rifampin. Prevention and control of MDRTB represent an important growing challenge to public health in industrialized countries and in countries with limited resources. The worldwide upsurge of MDRTB in the 1990’s was associated with multiple factors, including the human immunodeficiency virus (HIV) epidemic, sub-optimal patient adherence with curative therapy, and transmission of MDRTB in healthcare and other institutional settings. One important component of the overall control of MDRTB is the prevention of transmission of Mycobacterium tuberculosis (MTB) in health care settings, or nosocomial transmission. Although there is no ongoing surveillance system for nosocomial or occupational MTB infections or disease, recent studies suggest annual tuberculin skin test (TST) conversion rates among health care workers (HCWs) range from 0.3 to 5.5% [1–5]. Similarly, studies suggest that the risk of developing active tuberculosis (TB) is higher among HCWs than the general population in the United States, especially in areas where TB prevalence is high [5–8]. The centerpiece of any effort to prevent nosocomial transmission of MTB is the development of an effective TB control program within the healthcare facility. In this chapter, we will review administrative, engineering, and personal respiratory protective measures that form the core of an effective TB control program. Such measures also reduce the nosocomial transmission of MDRTB. Recommendations for these measures are based on guidelines published by the Centers for Disease Control and Prevention (CDC), which are primarily aimed towards developed countries [9]. In addition, we discuss measures for prevention of MTB transmission that can be undertaken in countries and regions with limited resources.