Reducing the risk of tuberculosis transmission for HCWs in high incidence settings

Abstract

Globally, tuberculosis (TB) is a leading cause of death from a single infectious agent. Healthcare workers (HCWs) are at increased risk of hospital-acquired TB infection due to persistent exposure to Mycobacterium tuberculosis (Mtb) in healthcare settings. The World Health Organization (WHO) has developed an international system of infection prevention and control (IPC) interventions to interrupt the cycle of nosocomial TB transmission. The guidelines on TB IPC have proposed a comprehensive hierarchy of three core practices, comprising: administrative controls, environmental controls, and personal respiratory protection. However, the implementation of most recommendations goes beyond minimal physical and organisational requirements and thus cannot be appropriately introduced in resource-constrained settings and areas of high TB incidence. In many low- and middle-income countries (LMICs) the lack of knowledge, expertise and practice on TB IPC is a major barrier to the implementation of essential interventions. HCWs often underestimate the risk of airborne Mtb dissemination during tidal breathing. The lack of required expertise and funding to design, install and maintain the environmental control systems can lead to inadequate dilution of infectious particles in the air, and in turn, increase the risk of TB dissemination. Insufficient supply of particulate respirators and lack of direction on the re-use of respiratory protection is associated with unsafe working practices and increased risk of TB transmission between patients and HCWs. Delayed diagnosis and initiation of treatment are commonly influenced by the effectiveness of healthcare systems to identify TB patients, and the availability of rapid molecular diagnostic tools. Failure to recognise resistance to first-line drugs contributes to the emergence of drug-resistant Mtb strains, including multidrug-resistant and extensively drug-resistant Mtb. Future guideline development must consider the social, economic, cultural and climatic conditions to ensure that recommended control measures can be implemented in not only high-income countries, but more importantly low-income, high TB burden settings. Urgent action and more ambitious investments are needed at both regional and national levels to get back on track to reach the global TB targets, especially in the context of the COVID-19 pandemic.

Bacteriophages of Mycobacterium tuberculosis, their diversity, and potential therapeutic uses: a review

“…Close contact and inhalation in the same nearby environs among patients with TB and susceptible persons cause the extent of TB. Numerous studies have revealed that TB patients need reception to the ICU conveys a high mortality level of 25–63% [ 17 , 18 ]. Delays in treatment or diagnosis could lead to acute disease and higher mortality rates.…”

Mycobacterial Rv1804c binds to the PEST domain of IκBα and activates macrophage-mediated proinflammatory responses

“… 1 , 2 The emergence of multidrug-resistant Mtb , human immunodeficiency virus coinfection, and the coronavirus disease 2019 pandemic has urgently warranted TB control. 3 Furthermore, developing new TB vaccines and therapies by comprehensively understanding the close interaction between Mtb and host immunity is vital.…”

Accuracy of digital chest x-ray analysis with artificial intelligence software as a triage and screening tool in hospitalized patients being evaluated for tuberculosis in Lima, Peru

“…Healthcare facilities are known hotspots for TB transmission in high-incidence settings [ 3 – 7 ]. Globally, the rate of TB disease among healthcare workers is estimated to be at least double that of the general adult population, suggesting significant transmission in health facilities [ 8 , 9 ]. The FAST (Find cases Actively, Separate safely, and Treat effectively) strategy was developed to reduce TB transmission in healthcare settings, based on the principle that most transmission occurs from patients with unsuspected and thus undiagnosed TB, including drug-resistant strains [ 10 ].…”