Intended for healthcare professionals

Practice Practice Pointer

How to minimise risk of acquiring tuberculosis when working in a high prevalence setting: a guide for healthcare workers

BMJ 2011; 342 doi: (Published 16 March 2011) Cite this as: BMJ 2011;342:d1544
  1. Tara Harrop, NHS specialty registrar in public health, south west England 1,
  2. James Aird, NHS specialist registrar in orthopaedic surgery, Severn Deanery 1,
  3. Guy Thwaites, Wellcome Trust clinical research fellow23
    1. Correspondence to: T Harrop, Sandground Cottage, Bristol BS39 4BZ, UK taraharrop{at}
    • Accepted 20 February 2011

    Healthcare workers who travel to areas of high tuberculosis prevalence are at risk of infection—this article discusses precautions that can be taken before, during, and after exposure to minimise risk

    Many healthcare workers spend time working or travelling in areas with a high prevalence of tuberculosis, where rates of drug resistant disease are increasing. It is therefore increasingly important for them to be able to assess and reduce the risk of acquiring tuberculosis.

    In regions with a high prevalence of tuberculosis patients with undiagnosed or untreated disease are concentrated in hospitals, so healthcare workers are regularly exposed to Mycobacterium tuberculosis. Few visiting healthcare workers appreciate this risk when working in such settings.

    This article reviews the risk of healthcare workers contracting tuberculosis while working in areas of high risk. We discuss what workers should do before starting work; how they should protect themselves when at work; how to detect infection and what to do about it; and what needs to be done when they return to work in an area with a low prevalence of tuberculosis (box 1).

    Box 1 Precautions to take before, during, and after potential exposure to tuberculosis

    Before leaving
    • Determine the likely prevalence of tuberculosis in the work place, including the risk of contact with multidrug resistant strains

    • Undergo baseline chest radiography, tuberculin skin test or interferon γ release assay, and an HIV test

    • Have a BCG vaccination if not previously vaccinated and HIV negative

    • Purchase supply of N95 or FFP2 masks after fit testing

    While abroad
    • Maximise natural ventilation

    • Encourage patients with a cough or those known to be infectious to wear surgical masks

    • Wear a mask, especially when performing high risk procedures, such as intubation

    • Have chest radiography and tuberculin skin testing every three to six months and keep records of all tests

    • Remain attentive to symptoms of active disease

    On return
    • Report to occupational health before starting work explaining the nature …

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