TB In Healthcare Settings

The spread of TB in health care settings can be minimized by implementing CDC recommendations for preventing TB transmission in these settings. The early detection, airborne infection isolation, and treatment of disease in persons with infectious TB are essential to controlling transmission. TB should be suspected in all persons with symptoms consistent with TB (e.g., cough, fever, night sweats, chills, fatigue, weight loss, or loss of appetite), especially those with confirmed or suspected HIV infection and undiagnosed pulmonary disease. Precautions should be taken to prevent airborne transmission of M. tuberculosis until TB is diagnosed and treated or ruled out. In general, patients who have suspected or confirmed TB disease should be considered infectious if (a) they are coughing, undergoing cough-inducing procedures, or have positive sputum smear results for acid-fast bacilli (AFB); and (b) they are not receiving adequate ant tuberculosis therapy, have just started therapy, or have a poor clinical or bacteriologic response to therapy.

For patients placed under airborne precautions because of suspected infectious TB disease of the lungs, airway, or larynx, airborne precautions can be discontinued when infectious TB disease is considered unlikely and either another diagnosis is made that explains the clinical syndrome, or the patient produces three consecutive negative sputum smears collected in 8- to 24-hour intervals (one should be an early morning specimen). Patients for whom the suspicion of infectious TB disease remains after the collection of three negative sputum smear results should not be released from airborne precautions until they receive standard multidrug ant tuberculosis treatment (minimum of 2 weeks) and Demonstrate clinical improvement. For these patients, additional diagnostic approaches (e.g., sputum induction) and, after sufficient time on treatment, bronchoscopy may need to be considered. Patients who have drug-susceptible TB of the lung, airway, or larynx, should remain under airborne precautions until they Produce three consecutive negative sputum smears collected in 8- to 24-hour intervals (one should be an early morning specimen), and receive standard multidrug ant tuberculosis treatment (minimum of 2 weeks), and Demonstrate clinical improvement.

Precautions should be taken during and immediately after procedures that may induce coughing, such as bronchoscopy, sputum collection, the aerosol induction of sputum, and the administration of aerosolized medication, such as pentamidine. Antituberculosis drug treatment should be promptly initiated for persons with TB disease to render them noninfectious.

Persons at high risk for LTBI should be tested and, if infected, evaluated for LTBI treatment. Ongoing TB testing should be provided to health care workers who have regular contact with persons with TB or HIV infection.

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