17.3.2 Infection control in households
The important steps in effective infection control in households is the early identification of cases, adherence to treatment and implementation of proper TB infection control measures (e.g. cough manners and respiratory hygiene), before and after a diagnosis of TB in a family member. To reduce exposure in households the following additional measures should be taken:
- Houses should be adequately ventilated, by opening doors and windows, particularly rooms where people with infectious TB spend considerable time. Natural ventilation can be sufficient to reduce the likelihood of transmission of infection.
- Smear-positive TB patients should spend as much time as possible outdoors. They should sleep alone in a separate, adequately ventilated room, and spend as little time as possible in congregate settings or on public transport.
- The importance of infection control in the community should be promoted.
- In households with TB patients, additional guidance is important. Cough manners (including use of masks) and respiratory hygiene need to be adopted when in contact with people. Ideally, health service providers should wear respirators when attending patients in confined spaces.
Ideally, family members living with HIV, or family members with strong clinical evidence of HIV infection, should not provide care for patients with culture-positive drug-resistant TB. If there is no alternative, HIV-positive family members should wear respirators, if available. Children below five years of age should spend as little time as possible in the same living spaces as culture-positive drug-resistant TB patients. Such children should be followed up regularly with TB screening and, if positive, should be tested for drug-resistance and treated. If possible, renovation of the patient’s home should be considered, to improve ventilation (e.g. constructing a separate bedroom, or installation of a window or wind catcher, or both).