By the mid-1990s, hospitals, correctional facilities, and possibly other facilities began to report higher levels of adherence to CDC recommendations. On-site inspections and other data suggest the need for caution in assuming that written tuberculosis control policies represent routine institutional or worker practice.
Implementation of tuberculosis control measures appears to have contributed to ending outbreaks of tuberculosis and preventing new ones. Outbreak studies as well as logic, biologic plausibility, and modeling exercises support CDC’s hierarchy of tuberculosis control measures. That hierarchy stresses administrative controls (in particular, rigorous application of protocols to promptly identify and isolate people with signs and symptoms suspicious for infectious tuberculosis), followed by engineering controls and, finally, by personal respiratory protections. Especially in high-prevalence areas, occasional worker exposure to patients with infectious tuberculosis can still be expected, despite the implementation of generally effective protocols for respiratory isolation.