HomeIn remote and isolated communities there are many challenges to TB IPC. Resource limitations may result in difficulties with access to adequate diagnostic facilities for bacteriologic examinations and chest x-ray. A high index of suspicion for a patient having respiratory TB is required. If a chest x-ray is difficult to organize because patients must fly out of the community, then sending sputum samples for TB smear and culture, or nucleic acid amplification test, may be a more rapid way to make a diagnosis of respiratory TB, with less risk of transmission to others. Cohorting may need to be considered as a strategy to accommodate inpatients with respiratory TB if there are insufficient numbers of AII or private rooms.
Recommendations
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We conditionally recommend that, if patients with respiratory TB need admission for medical attention and cannot be transferred to a facility with an airborne infection isolation room, cohorting patients with smear-positive TB may be considered, provided they are receiving treatment and there is no suspicion of drug resistance (and/or the prevalence of drug-resistance is known to be very low) (poor evidence).
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We conditionally recommend establishing effective community-based treatment programs (in homes) to complete treatment started in the hospital (poor evidence).
Good practice statements
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Healthcare facilities that care for populations at-risk for TB should have access to Infection Prevention and Control and Occupational Health Safety and Wellness expertise that will facilitate implementation of engineering, administrative and personal protective equipment controls.
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Outpatient visits from people with, or being evaluated for, respiratory TB should be scheduled at the end of the day or after regular hours.
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