Administrative measures in health facilities — MSF Tuberculosis

What this guideline says

GMJ summary

This section of the MSF Tuberculosis guideline outlines administrative measures for preventing Mycobacterium tuberculosis transmission in health facilities. Administrative controls form the foundation of TB infection prevention and control (TB-IPC) and include risk assessment, development of a written TB-IPC plan, assignment of an IPC practitioner with authority and resources, staff training, patient triage, early diagnosis and treatment, and separation/isolation of infectious patients.

The guideline emphasizes that patients with pulmonary TB are no longer considered infectious after 2 weeks of effective treatment, making early diagnosis and treatment initiation essential. Health facilities should categorize areas by transmission risk (high, limited, or low) and display floor plans showing these zones. High-risk areas include sputum collection sites, laboratories preparing specimens, infectious TB patient wards, diagnostic rooms, and waiting rooms in high-prevalence settings.

For inpatient facilities, the guideline recommends hospitalizing only severely ill patients who cannot be managed as outpatients, grouping patients by infectiousness and resistance profile, prioritizing single rooms for patients with unknown status or difficult-to-treat resistance, and maintaining isolation during ambulance transport. Staff training on TB-IPC should occur at implementation, when measures change, for new hires, and at least annually for all staff.

Key points

For clinicians — doses and thresholds as stated in the guideline

1. Patients with pulmonary TB are no longer considered infectious after 2 weeks of effective treatment
2. Initial TB risk assessment required, with periodic re-evaluation at least annually
3. Health facilities must develop a written TB-IPC plan with areas categorized as high risk (sputum collection, laboratory specimen preparation, infectious TB wards, diagnostic rooms, waiting rooms in high-prevalence areas), limited risk (pediatric wards, extrapulmonary TB wards, smear/culture-negative PTB areas), or low risk (kitchen, administration, pharmacy, technical services)
4. Assign an IPC practitioner with authority, budget, and human resources to implement TB-IPC measures
5. Provide staff training on TB-IPC at plan implementation, when measures change, for new hires, and at least once annually for all staff
6. In inpatient facilities, place patients in single rooms when possible, or rooms with 2 to 4 beds maximum, grouping by infectiousness and resistance profile
7. Prioritize single rooms for patients pending diagnosis and those with highest infectiousness or most difficult-to-treat resistance
8. Replace inpatient sputum containers daily; do not fill used containers with chlorine solution before incineration to avoid toxic gases

Levels of risk in TB facilities

Table extracted from the guideline

Source: Médecins Sans Frontières, Administrative measures in health facilities — MSF Tuberculosis. Reproduced in summary form.

From the guideline

Verbatim

“Patients with PTB are no longer considered as infectious after 2 weeks of effective treatment.”

Editor’s perspective

Why this matters for Georgia and the region

Applicability

Georgia and the South Caucasus

Questions this guideline answers

Quick answers

Related on GMJ

Interconnected resources

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