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. 2010 Aug 2;24(3):655–680. doi: 10.1016/j.idc.2010.04.013

Table 3.

Effect of administrative, personal, and engineering control measures applied concurrently on nosocomial transmission of TB

LMIC
Author, Year Country Facilities Year of intervention Preventive Strategy Used Epidemiologic Measure in Absence of Preventive Measure Epidemiologic Measure in Presence of Preventive Measure Effect
Administrative Personal Engineering
Harries 2002,65 Malawi
40 TB care facilities
(1998)
  • (1)

    Priority to patients with chronic cough in OPD

  • (2)

    Rapid sputum collection, transport and reporting

  • (3)

    Visitors kept to a minimum

  • (4)

    CXR at quiet times of the day

  • (5)

    Patients with TB spend more day time outdoors when possible
  • (1)

    Proper cough hygiene

  • (2)

    Mask worn by patients with TB when undergoing surgical procedures
  • (1)

    Increased natural ventilation

  • (2)

    Windows left open most of the time

  • Incidence of TB disease before prevention (1996)

  • Clin officer 7407

  • Pt attd 5014

  • Wd attd 3543

  • TB officer 3030

  • Nurses 2835

  • Overall 3707

  • Incidence of TB disease after prevention (1999)

  • Clin officer 3603

  • Pt attd 4348

  • Wd attd 3954

  • TB officer 1785

  • Nurses 2060

  • Overall 3222

  • Incidence of TB disease declined after preventive measures used.

  • Statistically NS
Yanai 2003,47 Thailand
Provincial referral hospital
(1997–98)
  • (1)

    Early suspicion of TB

  • (2)

    Early sputum collection and reporting

  • (3)

    Early initiation of TB treatment

  • (4)

    Isolation of patients with TB

  • (5)

    One-stop OPD TB service
  • (1)

    N95 mask use by HCWs

  • (2)

    HEPA filter in laboratory areas
  • (1)

    TB isolation room in wards

  • (2)

    Maximizing ventilation in wards

  • (3)

    Class II safety cabinets in laboratory

  • (4)

    UVGI system in laboratory

  • Incidence of TB disease control measures (1995–1997)

  • All HCWs 179.21

  • Annual incidence of LTBI before control measures (1995–97)

  • 9.3% (3.3%–15.3%)

  • Incidence of TB disease after control measures (1999)

  • All HCWs 252.68

  • Annual incidence of LTBI after control measures (1999)

  • 2.2% (0%–5.1%)

  • Increase in TB disease

  • Statistically NS

  • Decrease in LTBI rates

  • Statistically significant
Roth 2005,45 Brazil.
2 hospitals with, and 2 without control measures
(1998)
  • (1)

    Rapid diagnosis and treatment of Patients with TB

  • (2)

    Isolation of patients with TB in private rooms
  • (1)

    N95 mask use by HCWs

  • (2)

    HEPA filter in laboratory areas
  • (1)

    Negative pressure roomsa (one hospital)

  • (2)

    Class II biosafety cabinets in laboratory areas

  • Incidence of LTBI in 2 hospitals without control measures

  • (1998–99)

  • 16 per 1000 person-months

  • Incidence of LTBI in 2 hospitals with control measures

  • (1998–99)

  • 8 per 1000 person-months

  • Difference in LTBI rates

  • Statistically significant
High-Income Countries
Author, Year Country Workers Facilities Year of Intervention TST Baseline Conversion Definition Infection Control Strategy Used
 Outcomes
Administrative Personal Engineering Measure Before After
Wenger 1990102
United States

  • All HCW

  • 1 hospital

  • 1991

  • 1-Step

  • T1<10, T2≥10 mm

  • TST ≥10 mm and ↑ 6+ mm

  • ↑ Isolation

  • ↑ Speed for AFB

  • Sputum induction in respiratory isolation rooms

  • TST every 4 mo

  • Sub-μm masks

  • Dust-mist masks

  • Auto door closers

  • Negative pressure isolation rooms

  • Conv/tested

  • ARI

  • 7/25

  • 28%

  • 3/17

  • 18%
Maloney 1991103
United States

  • All HCW

  • 1 hospital

  • 1991

  • 1-Step

  • T1<10, T2≥10 mm

  • ↑ Isolation

  • ↑ Treatment

  • ↑ Speed for AFB

 Molded surgical masks Window exhaust fans Conv/tested ARI

  • 26/840

  • 3.1%

  • 22/727

  • 3.0%
Fella 1991104
United States

  • All HCW

  • 1 hospital

  • 1991–1993

  • 1-Step

  • T1<10, T2≥10 mm

 ↑ Isolation Better mask (dust-mist) Window exhaust fans
Upper air UV light		 Conv/tested ARI

  • 30/145

  • 21%

  • 51/1007

  • 5.1%
Bangsberg 1992105
United States

  • Residents

  • 1 hospital

  • 1992

  • 1-Step

  • T1<10, T2≥10 mm and ↑ 6+ mm

 ↑ Isolation Respiratory masks Negative pressure rooms in ER+OPD
Upper-air UV lights		 Conv/tested ARI

  • 11/90

  • 5.4%

  • 1/90

  • 0.7%
Blumberg 1992106
United States

  • All HCW

  • 1 hospital

  • 1991–1992

  • 1-Step

  • T1<10, T2≥10 mm

 ↑ Respiratory isolation TST every 6 months Sub-μm masks Window exhaust fans Conv/tested ARI 118/3579
3.3%		 185/17618
1.1%
Boudreau 199718
United States

  • All HCW

  • 1 hospital

  • 1989–1992

  • 1-Step

  • T1<10, T2≥10 mm

  • Drug therapy improved

  • ↑ Isolation procedures

  • Worker education

 Better masks Sputum induction booth
UV lights		 ARI in HCW 6.9% 1.9%
Blumberg 199817
United States

  • Residents

  • 1 hospital

  • 1992–1997

  • 1-Step

  • T1<10, T2≥10 mm

  • Isolation procedures

  • TB infection control nurse

 Better masks
TST of HCWs		 50 respiratory isolation rooms ARI in HCW 6% 1.1%
Louther 199726
United States

  • All HCW

  • 1 hospital

  • 1991–1994

  • 1-Step

  • T1<10, T2≥10 mm and ↑ 10+ mm

 ↑ Isolation Better masks ↑ Ventilation ARI in HCW 7.2% 4.8%

Abbreviations: ARI, annual risk of infection; Clin officer, clinical officer; Conv, conversions; CXR, chest radiograph; ER, emergency room; HCW, health care worker; HEPA, high-efficiency particulate air; NS, nonsignificant; OPD, outpatient department; Pt attd, patient attendant; Wd attd, ward attendant.

a

Single rooms, R6 air changes per hour, negative pressure or inward airflow, automatic door closing.