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TB Facts for Health Care Workers
2006
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Infection Control Measures
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
antituberculosis 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
antituberculosis 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 antituberculosis 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.
| Remember! The key to preventing
LTBI and death and disability from TB disease is to consider the
possibility of TB in high-risk groups, make the diagnosis as quickly
as possible, and initiate effective, directly observed drug therapy
for persons found to have TB. Think TB! |
Last Reviewed: 05/18/2008
Content Source: Division of Tuberculosis Elimination
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
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