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Healthcare workers globally face an elevated risk of tuberculosis (TB) infection and disease due to their occupational exposure. While significant progress has been made in developing infection prevention and control (IPC) guidelines over the past 25 years, studies continue to show inadequate implementation and persistent risk in various settings. To effectively protect healthcare workers and ensure a safe working environment, a comprehensive occupational health approach is essential, complementing existing IPC guidelines.
The Problem of TB Among Healthcare Workers
Healthcare workers in low- and middle-income countries (LMICs) are disproportionately affected by TB, with studies reporting a pooled incidence rate ratio for active TB disease of 2.94 and a pooled odds ratio for latent TB infection (LTBI) of 2.27, compared to control populations. In high-HIV-burden countries, the risk is further exacerbated by the high prevalence of HIV infection among healthcare workers, which significantly increases their susceptibility to TB. The rise of drug-resistant TB has also intensified the threat associated with the disease.
Infection Prevention and Control Guidelines
Infection Prevention and Control Guidelines
Efforts to address TB transmission in healthcare settings have been ongoing since the publication of guidelines by the U.S. Centers for Disease Control and Prevention (CDC) in 1994, which were updated in 2005 in response to a resurgence of TB and nosocomial transmission in U.S. hospitals . The World Health Organization (WHO) has also published guidelines for low-resource settings, along with supporting documents on IPC implementation and providing healthcare and related services for affected health workers.
The Need for a Comprehensive Occupational Health Approach
While IPC guidelines have been instrumental in addressing TB transmission in healthcare settings, their implementation could have been better in many countries. To effectively protect healthcare workers, a comprehensive occupational health approach is necessary, focusing on upstream or mediating components such as statutory regulation, leadership, information systems, and staff trained in protective disciplines.
Conclusion
Healthcare workers worldwide face a significant burden of TB due to their occupational exposure. While IPC guidelines have been instrumental in addressing TB transmission in healthcare settings, their implementation could have been better in many countries. A comprehensive occupational health approach is essential to protect healthcare workers and ensure a safe working environment, focusing on statutory regulation, leadership, information systems, and capacity building. By adopting this approach and complementing it with effective IPC measures, we can significantly reduce the burden of TB among healthcare workers and ensure a healthier, more resilient healthcare workforce.