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Protection of healthcare workers against transmission of Mycobacterium tuberculosis in hospitals: a review of the evidence

Roland Diel, Albert Nienhaus, Peter Witte, Renate Ziegler
ERJ Open Research 2020 6: 00317-2019; DOI: 10.1183/23120541.00317-2019
Roland Diel
1Institute for Epidemiology, University Medical Hospital Schleswig-Holstein, Airway Research Center North (ARCN), Kiel, Germany
2Lung Clinic Grosshansdorf, ARCN, German Center for Lung Research (DZL), Großhansdorf, Germany
3Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), Hamburg, Germany
4German Central Committee against Tuberculosis, Berlin, Germany
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  • For correspondence: roland.diel@epi.uni-kiel.de
Albert Nienhaus
3Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), Hamburg, Germany
5Institute for Health Service Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Peter Witte
4German Central Committee against Tuberculosis, Berlin, Germany
6Institute for Hospital Hygiene, Johannes Wesling Hospital Minden, University Medical Hospital of Ruhr University Bochum, Minden, Germany
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Renate Ziegler
7Institute for Clinical Hygiene, Medical Microbiology and Infectiology, Paracelsus Medical School, Klinikum Nürnberg, Nuremberg, Germany
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Tables

  • TABLE 1

    Air changes per hour (ACH) and removal efficiencies of Mycobacterium tuberculosis droplets

    ACHTime required for removal efficiency min
    99%99.9%
    2138207
    469104
    64669
    122335
    201421

    Reproduced and modified from [4].

    • TABLE 2

      Comparison of guidelines on selected preventive measures for protection against Mycobacterium tuberculosis in hospitals separated by topics

      Guidelines/recommendationsWHO [6, 7]USA [4, 12, 24, 26]UK [5, 8, 25]Germany [3, 9, 13, 23]
      Spatial requirements
       NPI roomsYesYesYesYes
       Normal ventilation room allowedYesYes, if air-cleaning technologies (e.g. a portable HEPA filtration system) are availableYes, single rooms that are vented to the outside of the buildingYes, single rooms that are vented to the outside of the building
       Frequency of air exchange in NPI roomsMinimum 12 per hPrefer ≥12 per h (minimum ≥6 per h)“Adequate ventilation”Optionally 12 per h
       Frequency of air exchange in normal ventilation roomsNot addressedMinimum 2 per hNot addressedNot addressed
      Personal protection
       Minimum standard of masksN95 or FFP2N95 or FFP2FFP2FFP2
       Masks when encountering MDR-TB patients
      FFP3 not addressed>N95FFP3FFP3
       Masks during aerosol-generating procedures
      FFP2>N95FFP2 [5], FFP3 [8]FFP2 [3] or at least FFP 2 [23]
      Removal from isolation
       Sputum smear-positive patientsDiscussed, but no recommendation providedMinimum 2-week treatment, progressively decreasing M. tuberculosis load, then 3 microscopy-negative sputum smear-resultsOnly after at least 2-week treatment, and given a low initial smear (grade 2 or less), then 3 negative sputum smear resultsAfter 3-week treatment [23] or after 3-week treatment and 3 microscopy-negative sputum smear results [3], in each case dependent on clinical and radiographic improvement
       Sputum smear-negative patientsNot addressedAfter two negative results of the Xpert MTB/RIF testNo isolationAfter 3 microscopy- negative sputum results, depending on further medical consideration [3] or after 3-week treatment and clinical and radiographic improvement [23]
       MDR-TB patientsNot addressed (isolation only for culture-positive XDR-TB patients)After at least 1 negative cultureAfter 3 microscopy-negative smears at weekly intervals and ideally 1 negative cultureAfter 3 microscopy-negative smears, possibly after 1 negative culture [3] or definitely after 1 negative culture [23]
      Screening for LTBI
       Serial testing of healthcare workersNot addressedAt the discretion of healthcare facilities; routine serial testing not recommendedNot addressed (BCG vaccination instead?)Yes, required by law (Ordinance of Occupational Health Care) in risk-prone healthcare facilities
      Disinfection
       Upper-air or in-duct UV disinfection (UVGI)
      YesYes, but not in lieu of ventilationNot addressedNoted as general option, but not recommended

      WHO: World Health Organization; NPI: negative pressure isolation; HEPA: high efficiency particulate air; FFP: filtering face piece; MDR: multidrug-resistant; XDR: extensively drug-resistant; TB: tuberculosis; RIF: rifampicin; XDR: extensively drug resistant; LTBI: latent TB infection; BCG: bacille Calmette–Guérin; UVGI: ultraviolet germicidal irradiation.

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      Protection of healthcare workers against transmission of Mycobacterium tuberculosis in hospitals: a review of the evidence
      Roland Diel, Albert Nienhaus, Peter Witte, Renate Ziegler
      ERJ Open Research Jan 2020, 6 (1) 00317-2019; DOI: 10.1183/23120541.00317-2019

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      Protection of healthcare workers against transmission of Mycobacterium tuberculosis in hospitals: a review of the evidence
      Roland Diel, Albert Nienhaus, Peter Witte, Renate Ziegler
      ERJ Open Research Jan 2020, 6 (1) 00317-2019; DOI: 10.1183/23120541.00317-2019
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