Tuberculosis Risk Assessment in a Health-Care Facility

 

Step 1: Review the community tuberculosis profile and the number of TB patients seen in the health care facility as inpatients and outpatients.

(1a) If there have been no cases of tuberculosis in the facility or community during the past year, then the facility is termed minimal risk . Re-evaluation of the facility is performed at an appropriate interval.

 

Step 2: If there have been TB patients in the community or facility, then analysis of cases is performed, paying attention to:

(2a) the health care worker PPD conversion rate relative to the previous conversion rates and relative to rates seen at facilities or areas with low occupational exposure to tuberculosis

(2b) any clusters of health care worker PPD conversions

(2c) evidence of person-to-person spread

 

Step 3: If there is no evidence of increased transmission, then the facility is subclassified as follows:

(3a) If no TB patients have been admitted to the facility during the preceding year, and if the facility refers all cases with suspected or confirmed tuberculosis requiring inpatient care to another health care facility, then the facility is termed very low risk .

(3b) If less than 6 TB patients have been admitted to the area during the preceding year, then the facility is termed low risk .

(3c) If 6 or more patients with TB have been admitted to the area during the preceding year, then the facility is termed intermediate risk .

(3d) Re-evaluation of the facility is performed at an appropriate interval.

 

Step 4: If there is evidence of tuberculosis transmission in the facility, then an analysis is performed to attempt identification of the causes for transmission.

(4a) If the causes of transmission cannot be identified or corrected, then the facility is termed high risk , and consultation needs to be obtained to study the situation.

 

Step 5: If the cause of any transmission is identified and controlled, then the facility is reanalyzed in 3 months.

(5a) If there is no evidence of additional transmission, then the facility reverts to a lower risk group. Further re-evaluation of the facility is performed at an appropriate interval.

 

Step 6: If evidence of new transmission has occurred, then the interventions are reassessed and the facility is reanalyzed again in 3 months.

(6a) If there is no further transmission, then the facility reverts to a lower risk group. Re-evaluation of the facility is performed at an appropriate interval (step 5).

(6b) If transmission is shown, then the facility is termed high risk and consultation needs to be obtained to study the situation (step 4).