Guideline: Infection Prevention and Control Guidelines for TB, MDR-TB and XDR-TB » How to Ensure Infection Prevention and Control in Congregate Setting?

12. How to Ensure Infection Prevention and Control in Congregate Setting?


1. TB wards

One of the most effective means to reduce the risk of transmission of M. tuberculosis in hospital settings is to manage TB patients in the outpatient setting whenever possible. Many patients can be managed entirely as outpatients, thereby avoiding hospitalization and the risk of exposing other patients and staff. If hospitalized, patients should be re-evaluated frequently for possible discharge with continuation of treatment as outpatients. Ideally, infectious TB patients should be isolated from other patients to prevent others from being exposed to the infectious droplet nuclei that they generate. If sputum smear is performed at the time of admission, those who have positive sputum smear results, and thus most infectious, should be isolated or separated from other TB patients already on treatment.

The hospital administration should ensure that:

  • There is a limited number of areas (preferably none) in the facility where exposure to potentially infectious TB patients may occur.
  • Separate wards for confirmed infectious TB patients are established. These wards should be located away from wards with non-TB patients, especially wards with paediatric or immuno-compromised patients.
  • In the outpatient setting, early identification, diagnosis, and treatment of TB cases is the highest priority.
  • X-ray  departments  schedule  inpatient  chest  x-ray appointments  for  patients  with  confirmed  or unconfirmed PTB during non-peak times.
  • Surgical masks are provided to coughing patients to wear when leaving isolation wards for any reason and in crowded waiting areas.

Isolation may be in patient’s homes, hospitals, or at designated TB or MDR-TB hospitals. Isolation is voluntary however; it may be legally enforced where a patient poses a risk to the public. Patients should remain in isolation until they are not infectious. People with infectious tuberculosis who are ill must be admitted in separate wards from other patients and their movement restricted to prevent the spread of infection. Ideally patients with suspected or confirmed infectious PTB should be admitted in a single ward that has;

  • Monitored negative air pressure
  • 6 –12 air changes per hour
  • Appropriate discharge of room air to the outside
  • Monitored high efficiency filtration of room air before the air is circulated to other areas of the hospital.
  • Simple extraction fan providing at least 6 air changes per hour or
  • Open windows and adequate ventilation.

When single wards are not available the patient should be placed in a ward with patients who are infected with the same micro-organisms. Patients at the same stage of treatment may be admitted in the same wards – cohorting. The same environmental measures as mentioned above apply in such a ward.

2. Patient transportation

The ventilation system in the ambulance should be circulate air within the vehicle but facilitate dilution by bringing in air from outside. If the vehicle has a rear exhaust fan, the fan must be on during transport. Air should flow from the front of vehicle, over the patient, and out through the rear exhaust fan.

After transporting the patient the vehicle must be ventilated by opening all doors and windows switching on the fans to flush out the air inside the vehicle.

If patient transport vehicles are used to transport a patient with infectious TB disease;

  • If possible separate the infectious patients from other patients.
  • The patient must wear a surgical mask
  • Ensure that all windows are open.
  • Educate patients in transit, driver and the accompanying staff on the use of masks and respirators.

3. Correctional facilities

Compared with the general population, TB prevalence is higher among inmates and it is associated with a higher prevalence of HIV infection, overcrowding, suboptimal ventilation, longer duration of potential exposure and limited access to health care services. TB is a public health concern in correctional facilities; employees and inmates are at high risk of infection. All correctional facilities must therefore have a written TB infection prevention and control plan based on the TB risk assessment report.