Evidence for the Use of Triage, Respiratory Isolation, and Effective Treatment to Reduce the Transmission of Mycobacterium Tuberculosis in Healthcare Settings: A Systematic Review

Abstract

Evidence is limited for infection prevention and control (IPC) measures reducing Mycobacterium tuberculosis (MTB) transmission in health facilities. This systematic review, 1 of 7 commissioned by the World Health Organization to inform the 2019 update of global tuberculosis (TB) IPC guidelines, asked: do triage and/or isolation and/or effective treatment of TB disease reduce MTB transmission in healthcare settings? Of 25 included articles, 19 reported latent TB infection (LTBI) incidence in healthcare workers (HCWs; absolute risk reductions 1%-21%); 5 reported TB disease incidence in HCWs (no/slight [high TB burden] or moderate [low burden] reduction) and 2 in human immunodeficiency virus-positive in-patients (6%-29% reduction). In total, 23/25 studies implemented multiple IPC measures; effects of individual measures could not be disaggregated. Packages of IPC measures appeared to reduce MTB transmission, but evidence for effectiveness of triage, isolation, or effective treatment, alone or in combination, was indirect and low quality. Harmonizing study designs and reporting frameworks will permit formal data syntheses and facilitate policy making.

Keywords: LTBI; healthcare worker; infection; occupational health; prevention.

Figure 1.

PRISMA flow diagram showing databases searched; numbers of records identified, sifted, reviewed, and included; and reasons for exclusion. *References and citations were checked for 25 primary research articles, 19 systematic reviews, and six guidelines (see Supplementary table 3). Abbreviations: PRISMA, preferred reporting items for systematic reviews and meta-analyses; Refs, references; SR, systematic review; WoS, Web of Science.

Figure 2.

Venn diagrams showing overlap between interventions implemented in the 25 studies included. A, Overlap between the 3 interventions of interest. B, Overlap between the 3 interventions of interest and other IPC measures implemented. *Includes administrative, personal protective, and environmental IPC measures. Figure developed using Venny v2.1 [23], Inkscape (https://inkscape.org/), and GIMP (https://www.gimp.org/) software. Abbreviation: IPC, infection prevention and control.