Engaging health-care workers to reduce tuberculosis transmission
The Lancet Infectious Diseases
Authors:Nathavitharana R., Peters, J., Lederer, P., von Delft, A., Farley, J. E., Pai, M., Jaramillo, E., Raviglione, M., & Nardell, E.
Although the proportion of global tuberculosis cases that arise from nosocomial transmission is unknown, many studies document that ongoing transmission in health-care facilities, primarily from undetected cases, is an important driver of the tuberculosis epidemic. Health-care workers are disproportionally affected by the occupational hazard of tuberculosis transmission, with at least a three times higher incidence of active tuberculosis shown in low-income and middle-income countries. A similar situation is also likely to affectcommunity care providers in regions with a high tuberculosis burden, although data are scarce. Despite the existence of evidence-based guidelines on tuberculosis-specific infection control, studies evaluating tuberculosis in affected health-care workers in resource-limited settings identified a lack of tuberculosis infection control programmes in most health-care facilities. The use of personal protective equipment is consistently sub-optimal, and reliable access to N95 respirators, which are standard respiratory protection masks, is often missing. Although the ethical obligation of health-care workers to provide care to patients might involve some degree of risk, there is also an ethical duty for those responsible for health systems to provide health-care workers with a safe working environment.