15. What are the Infection Prevention and Control Measures for Household?

Patients who have confirmed infectious TB disease are frequently sent home after starting initiation of treatment, even though they are still infectious. At the time of diagnosis they have most likely transmitted infection to household members. Therefore steps must be taken to prevent further spread of infection at home and to screen all household contacts for TB disease or infection. Community health care workers who provide services in the patient’s homes must be trained on the following;

• educating patients regarding the importance of reporting symptoms or signs of TB disease early and the importance of reporting any adverse effects to treatment
• counselling of patients on treatment adherence
• administering DOT and providing support to the patient
• precautions to be taken when collecting sputum
• educate the patient and family members on cough hygiene and importance of ventilation
• the importance of using N95 masks when entering a home/ room of a person with confirmed or suspected infectious TB
• the importance of undergoing routine medical screening for TB disease and screening for risk factors

1. Administrative controls

• Ensure treatment compliance at home: Care and support must be provided to the patient by community health workers.
• Screen all close contacts for TB symptoms: people who are symptomatic must be investigated for TB, children less than 5 years and all people living with HIV in the household must be offered IPT.
• Education: Educate patients, family members, care providers, and close contacts on the importance of isolation and infection control measures to be implemented at home.
• Hospital isolation: Patients with confirmed infectious TB disease and family support or homeless must be admitted and isolated in the hospital. This will ensure that risk of infecting others is minimized and treatment compliance.

2. Environmental controls

Windows and doors must be kept open (weather permitting) to increase the ventilation and dilution of infectious droplet nuclei in the house. If a sputum sample needs to be collected at home, this must be done in a well- ventilated preferably outside.

3. Personal protective equipment

• Patient: Mask: Patients do not need to wear masks at home once they are on adequate treatment (after two weeks of appropriate treatment). Give patients surgical masks and advise them to wear them at home if necessary, during transportation and medical consultations until they are no longer infectious.
• Healthcare Worker: Respirator: Healthcare workers should wear respirators when entering the home of a patient with infectious TB disease or when transporting a patient with infectious TB. The respirators should be NIOSH-approved (N-95 or higher) or E.U. specified filtering face piece FFP2. Healthcare workers should be provided with respirators after appropriate education and testing.

TB Infection Control measures in the home environment