Nardell Edward A
Harvard School of Medicine, School of Public Health, and the Program in Infectious Disease and Social Change, Department of Social Medicine, Harvard Medical School, Boston, MA, USA.
Semin Respir Infect. 2003 Dec;18(4):307-19. doi: 10.1053/s0882-0546(03)00069-0.
Current infection control guidelines for tuberculosis focus first on administrative interventions to promptly identify and isolate a known or suspected infectious case. Environmental control measures come next, and finally personal respiratory protection is recommended as a final strategy to prevent transmission. However, both environmental controls and the use of personal respiratory protection are also focused on known or suspected cases, and certain high-risk procedures. There is little focus on general medical areas where unsuspected cases are believed to transmit their infection before they become suspected cases. This review makes the case for increased attention to such areas as general medical wards, clinics, and waiting areas. Administrative controls are needed to improve detection and to reduce the possibility of transmission to high-risk groups. Improved air disinfection through general ventilation, filtration, and ultraviolet germicidal irradiation are needed as ways to address this overlooked source of transmission.
