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.

The Impact of Personal Protective Equipment on Healthcare Workers on COVID-19 Duty in a Tertiary Care Hospital in South India

“…The PPE kits are also used to treat tuberculosis, Middle East respiratory syndrome (MERS), and influenza. Hence, improving PPE quality can prevent HCWs from becoming infected [ 16 , 17 ]. A clinical trial had shown that N95 respirators are superior to surgical masks in preventing respiratory virus infection in healthcare workers [ 18 ].…”

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.…”

Knowledge, Attitudes, and Preventive Practices Regarding Tuberculosis Among Healthcare Workers and Patients in India: A Mixed-Method Study

“…Their knowledge, attitudes, and compliance with preventive precautions significantly impact disease transmission risks and mitigation [ 3 ]. However, evidence indicates sustained gaps in TB awareness and preventive practices among HCWs in high-burden countries [ 4 ].…”