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

• Published in: Clinical infectious diseases Vol. 72; no. 1; pp. 155 - 172
• Main Authors: Karat, Aaron S, Gregg, Meghann, Barton, Hannah E, Calderon, Maria, Ellis, Jayne, Falconer, Jane, Govender, Indira, Harris, Rebecca C, Tlali, Mpho, Moore, David A J, Fielding, Katherine L
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 23-01-2021
• Subjects: Delivery of Health Care; Health Facilities; Health Personnel; Humans; Infection Control; Latent Tuberculosis; Mycobacterium tuberculosis; Review; Triage; infection; LTBI; occupational health; healthcare worker; prevention
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/ciaa720

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.
Twenty-five articles were found. Most studies showed reduced latent tuberculosis infection or tuberculosis disease incidence after implementation of an intervention package, but evidence was weak for effectiveness of individual interventions. We make recommendations for future research to provide a better evidence base.