Evidence for the use of triage, respiratory isolation, and effective treatment to reduce the transmission of Mycobacterium tuberculosis in health care settings: a systematic review.

Evidence is limited for infection prevention and control (IPC) measures reducing Mycobacterium tuberculosis (MTB) transmission in health facilities. This systematic review, one of seven commissioned by the World Health Organization to inform the 2019 update of global tuberculosis (TB) IPC guidelines, asked: do triage and/or isolation and/or effective treatment of TB disease reduce MTB transmission in health care settings? Of 25 included articles, 19 reported latent TB infection (LTBI) incidence in health care workers (HCWs; absolute risk reductions 1%-21%); five reported TB disease incidence in HCWs (no/slight [high TB burden] or moderate [low burden] reduction) and two in HIV-positive in-patients (6%-29% reduction). 23/25 studies implemented multiple IPC measures; effects of individual measures could not be disaggregated. Packages of IPC measures appeared to reduce MTB transmission, but evidence for effectiveness of triage, isolation, or effective treatment, alone or in combination, was indirect and low quality. Harmonising study designs and reporting frameworks will permit formal data syntheses and facilitate policymaking.