expertise in all areas of TB control as well as ownership of the program through a
multidisciplinary input process.
II. Risk Assessment, Tuberculosis Plan, and Periodic Reassessment
An initial facility risk assessment must be undertaken. This includes gathering data regarding the following:
tuberculosis in the community, tuberculosis within the facility, skin test conversions within the facility, and
other evidence, if any, of person-to-person transmission of TB within the local health care setting. A
specific level of risk can be assigned for purposes of planning and monitoring or evaluating intervention
strategies to be incorporated into the written facility tuberculosis plan . The plan should include all
components of the tuberculosis control strategies for the facility in a format that is concise yet
comprehensive. It should be located in a single document or group of documents that are easily accessible
by hospital employees. Fragmentation of the tuberculosis control plan with multiple non-centralized
documents should be avoided.
This risk assessment will need to be redefined at intervals appropriate to the risk of transmission of
tuberculosis as defined by disease/infection prevalence in the community and the facility. Specifically,
changes in case rates for the facility or the community, clusters of skin test conversions, or other
evidence suspicious for facility TB transmission will necessitate immediate reevaluation of the facility
risk. The repeat risk assessment should also include evaluation of the effectiveness of the extant, local
methodologies for prevention of TB transmission.
III. Identification, Evaluation, and Treatment of Patients with Tuberculosis
The most important factors in preventing transmission of Mycobacterium tuberculosis are the early
identification of patients who may have infectious TB, prompt implementation of TB precautions for such
patients, and prompt initiation of effective treatment for those who are likely to have TB.
For patients presenting to the health care facility for care, screening for signs and symptoms of TB should
be done in the initial triage locale. The detail and extent of this screening process should be determined
based on the facility risk category. An example of a suitable screening methodology would be questioning
the patient regarding cough lasting greater than three weeks, weight loss, night sweats and malaise. A
facility should individualize its screening methodology in the most appropriate manner for its own risk
stratum based on perceived risk to other patients and employees. As patients present for care in high or
moderate risk areas, the issue of initial triage is extremely critical. Consideration should be given to speed
of triage, traffic patterns as patients move about the admissions area, clinic assignments, and risk to
employees performing administrative functions. Any triage system must be designed to prevent patients
with suspected or known infectious tuberculosis (S/KI TB) from moving about the facility in an
unprotected manner.
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