A New Class of Close Contacts: Home Health Care Workers and Occupational Exposure to Tuberculosis

Although the Centers for Disease Control published infection control guidelines for tuberculosis in hospital and outpatient clinic settings, recommendations are not clearly established for protection of health care workers (HCWs) in the home and field, despite increased emphasis on directly observed therapy (DOT). HCWs visit clients with infectious tuberculosis (TB) in homes, homeless shelters, drug rehabilitation programs, and outdoor settings, and transport clients in cars. HCW exposure to airborne droplet nuclei is most significant during field visits made shortly after the client is diagnosed and for prolonged periods when the client is nonadherent to therapy or has a drug-resistant isolate. In the absence of formal guidelines to limit field HCWs' exposure to TB, we have proposed measures for their TB program that outline for HCWs recommended care of a patient with TB and appropriate HCW education to minimize TB transmission and exposure.