In 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.
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).
We conditionally recommend establishing effective community-based treatment programs (in homes) to complete treatment started in the hospital (poor evidence).
Good practice statements
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.
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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