The South African Department of Health has published revised TB Infection Control guidelines in 2015, to provide guidance to management and staff in minimizing the risk of TB transmission in health care facilities, congregate settings (e.g correctional services) and communities.
When keeping in mind the context of high HIV, MDR-TB and XDR-TB burden in South Africa, it is apparent that the national guidelines on TB Infection control policy are vitally important. According to WHO, South Africa has the second highest number of reported multi-drug-resistant TB (MDR-TB) cases globally. Approximately 10.5% of MDR cases in South Africa have XDR-TB.
To address these issues, South Africa has widely embraced the concept of decentralization of DR-TB care and management. Instead of having to make long, and costly journeys to the MDR-TB centres, many patients can now access HIV and MDR-TB services close to their homes. Improved infection control measures will make healthcare environments safer for both staff, patients and the general population.
The recently revised guidelines have been expanded to address surveillance of TB disease among heath care workers; stipulating the frequency and type of screening. However, the risk of transmission of TB due to aerosol producing procedures that poses occupational risks in laboratories are not addressed. It also provides guidance on how to reduce TB transmission in households, as shown in Chapter 8. This document includes Risk Assessment Tools for hospital and primary health care facilities, as shown in Annexure B-D. In order to monitor implementation and the performance of Infection Control and Prevention control measures has identified a set of 4 core indicators.
In the past, TB infection control at community level was largely neglected in the policy and practice of TB control. However, recent outbreaks of XDR-TB with high mortality particularly in high HIV-prevalent settings have led to great interest on TB infection control in communities. The 2007 guidelines focused on work practices, administrative and environmental control measures and little emphasis was on respiratory-protection control measures.