Tuberculosis infection control in MDR-TB designated hospitals in Jiangsu Province, China

Hospital-acquired Tuberculosis (TB) infections among healthcare workers (HCWs) and patients present a significant challenge due to the increased risk of TB infection within healthcare settings.

A standardized assessment tool was applied for the evaluation, which involved direct observation, document review, and interviews with facility heads. A baseline evaluation of TB infection control (TBIC) measures in TB outpatient and inpatient departments, as well as laboratories, was completed by January 2019. Based on the results, a comprehensive intervention package was implemented, incorporating a three-tiered hierarchy of controls: administrative control (AC), environmental control (EC), and respiratory protection (RP). Subsequent monitoring was conducted quarterly, with corrective actions accordingly. More than two years of follow-up data were collected, with the collaboration of local hospitals, the municipality Centers for Disease Control and Prevention (CDC), and the Jiangsu Provincial CDC, concluding on August 31, 2021.

At baseline, the average implementation rates of AC, EC and RP were 57.3 %, 59.2 %, and 66.6 %, respectively. After the intervention, significant improvements were observed in key infection control measures. A triage process for cough patients was established, mechanical ventilation systems were installed, and the use of masks was improved. In addition, ultraviolet (UV) and upper-room ultraviolet germicidal irradiation (UVGI) systems were installed where required. As a result, the average implementation rates of AC, EC and RP significantly increased to 86.3 %, 87.4 %, and 98.4 % (P < 0.05), respectively. However, at the study's conclusion, Suzhou Fifth People's Hospital reported a lower AC implementation rate of 70.7 %, while Changzhou Third People's Hospital had an EC implementation rate of 68.1 %. These discrepancies were primarily attributed to suboptimal architectural designs that hindered proper ventilation in the wards.

This study demonstrates that designated hospitals still face persistent gaps in tuberculosis infection control (TBIC). However, over the course of one and a half years of targeted and standardized interventions, substantial improvements in TBIC practices were achieved across most participating institutions. Despite the suboptimal availability of dedicated TB wards, strengthening TBIC measures remains crucial to reducing TB transmission among healthcare workers and non-TB patients. This approach is both practical and scalable, particularly in high-burden TB settings. Nevertheless, the long-term efficacy and sustainability of these TBIC practices warrant ongoing evaluation.