1. Why Infection Prevention and Control Guidelines?

Most people with undiagnosed, untreated and potentially contagious TB are frequently seen in health care facilities but are missed. In an area with high HIV prevalence, this poses a risk for HIV positive patients who are particularly vulnerable to TB with a 10% annual risk of developing TB compared to a 10% lifetime risk in those with normal immunity. The numbers of patients with diagnosed or undiagnosed TB, immune compromised patients (HIV positive, children <5 years/ malnourished, diabetic) presenting to our health facilities creates a potential for transmission of TB. People who are immune compromised may become infected or re-infected with TB if they are exposed to someone with infectious TB disease. They can progress rapidly from TB infection to disease – over a period of months rather than a period of years as is common for persons with a normal immune system.

An increased risk of TB has been documented amongst all categories of health care personnel (including facility staff, community health workers and volunteers) compared to the general population. The prevalence of HIV amongst health care personnel correlates with that in the general population. Health care personnel are at risk due both to frequent exposure to patients with infectious TB. The rising incidence of Multidrug-Resistance Tuberculosis (MDR-TB) and Extensively Drug-Resistance Tuberculosis (XDR-TB) with high mortality have led to a stronger focus on TB infection control.

It is the responsibility of management and staff to minimize the risk of TB transmission in health settings. Infection control measures should be established to reduce the risk of TB transmission to both the general population and to health care personnel. Since the majority of patients are seen at primary health care level, it is important to ensure that infection prevention and control measures are implemented not only in the hospitals but clinics, community health centers and community or household level.