Tuberculosis in homeless, residential care facilities, prisons, nursing homes, and other close communities

Tuberculosis (TB) is a problem in some institutions, but not in others. Six factors may be used to assess the risk of TB in an institution: the entrance-point prevalence of infection among institutional residents and staff, the potential for reactivation, the role of transmission within the institution, the potential for detection of infection and disease, the potential for prevention and treatment of disease, and the potential of the building environment to favor transmission. The aging of the population, the crowding of prisons and the high prevalence of human immunodeficiency virus (HIV) infection are factors currently increasing the likelihood of TB in nursing homes, prisons, drug detoxification centers, and acute hospitals. Entrance-point skin testing, contact testing, periodic retesting, supervised preventive therapy, effective treatment of disease, and the selective application of ultraviolet air disinfection for certain high-risk areas are the suggested control strategies for hospitals, nursing homes, prisons, and chronic care facilities. However, for inner-city shelters and jails skin testing and preventive treatment are usually not possible, and the control strategy shifts to disease detection, isolation, effective long-term treatment, reduced crowding, ultraviolet air disinfection, and periodic testing and treatment of staff.