Annex 2. Facility tuberculosis risk assessment tool

This annex is based on a tool produced by Médecins Sans Frontières (MSF) (1).

Instructions: This tool helps to give an idea of the risk of transmission of Mycobacterium tuberculosis in health care facility or congregate settings. The results should be completed by the infection prevention and control (IPC) focal person and interpreted by the IPC committee. For the Yes/No questions, a Yes answer indicates good tuberculosis (TB) IPC practices. Any pertinent information on No answers is noted in the Comments section below each table.

Overview of the facility (interview with the health facility manager)


Administrative measures

Risk identification and segregation


Waiting areas (observe behaviour for 1 hour, ideally in the main (or in the specific TB) waiting area during the busy early morning hours


Management of persons with presumptive or confirmed TB (interview health care workers)


Sputum specimen collection and preparation (witness a sputum sample collection and preparation)


Staff measures (interview facility manager)


Environmental measures (If possible, make rough estimates of ventilation using a vaneometer and smoke tube or incense stick)


a If a mechanical system or GUV fixtures are used, explain their functioning and maintenance in detail in a separate sheet.

Obtain a scale drawing of the floor plan of the whole facility including doors and windows (if this is not available, make a sketch). Shade the different areas according to the level of risk based on the observations on environmental measures:

  • high risk of TB transmission – dark grey
  • limited risk of TB transmission – grey
  • low risk of TB transmission – white

Include patients and staff flow, and environmental measures (e.g. fans and GUV fixtures).


Personal protective measuresz (Walk unannounced around the facility and observe, then discuss with staff)


ACH: air changes per hour; ART: anti-retroviral therapy; DR-TB: drug-resistant TB; GUV: germicidal ultraviolet light; HIV: human immunodeficiency virus; IPC: infection prevention and control; OPD: outpatient department; SOP: standard operating procedure; TB: tuberculosis; TPT: TB preventive treatment; VCT: voluntary counselling and testing

Conclusions (debrief health facility manager after completing assessment)

According to the assessor and the facility manager, what are the current main issues and barriers in the implementation of TB IPC?

According to the assessor and the facility manager, what are the priority actions for the implementation of TB IPC in this facility for the next 6–12 months?

Reference for Annex 2

  1. Varaine F, Rich ML. Appendix 16. Basic TB infection control risk assessment tool, Tuberculosis: Médecins Sans Frontières, Partners In Health; 2023 (

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