The control of tuberculosis in healthcare settings requires a combination of different measures, as outlined below, with a focus on the role of the clinician.
a.
Administrative Controls
Examples include screening
healthcare workers who are at risk for TB disease and scheduling
non-emergent surgical, procedural and radiographic cases for
patients with TB at the end of the day to prevent exposure to
others.
b. Environmental
Controls
All patients with suspected or confirmed
pulmonary TB should be placed in a negative pressure/Airborne
Infection Isolation room.
c. Respiratory
Protection
All healthcare workers entering the room of a
patient with suspected or confirmed pulmonary tuberculosis should
wear a properly fitted N95 respirator. At EHC, OHS provides a
respiratory medical clearance and N95 fit testing on an annual
basis. For healthcare workers who cannot be fit tested (due to
facial hair, anatomic abnormalities, or claustrophobia), EHC
offers powered air purifying respirators (PAPRs).
d. Removing Patients with Suspected or Proven Tuberculosis from Airborne Precautions
Patients with suspected pulmonary tuberculosis:
The primary test for diagnosing active pulmonary TB is a sputum AFB stain and culture. Unfortunately, approximately half of patients who have active pulmonary TB will have negative sputum stains but positive sputum cultures. Patients who are AFB stain negative but culture positive are less contagious than stain positive patients, but they are still capable of transmitting tuberculosis.
Criteria for removing Airborne Precautions for patients with potential active pulmonary TB:
- EHC Hospitals: 2 negative sputum AFB stains at least 8 hours apart AND 1 negative MTB PCR (can be performed on same specimen as one of the AFB stains), assuming that an alternative diagnosis for their pulmonary disease has been made and/or they're improving on a regimen that does not treat tuberculosis. Infection Prevention must be contacted prior to discontinuation of Airborne Precautions.
- Grady Hospital: 2 negative sputum stains and one negative MTB PCR, unless a strong suspicion remains that the patient still could have pulmonary tuberculosis.
Patients with
confirmed pulmonary tuberculosis:
- Patients with active pulmonary tuberculosis typically remain in Airborne Precautions until discharged, as they rarely are hospitalized long enough to meet the criteria for removal. For patients with prolonged hospitalization (i.e. >2 weeks) and/or already on treatment for active tuberculosis at time of admission, please reach out to Infection Prevention to discuss appropriateness for removing Airborne Precautions.
- The discharge of patients being treated for active tuberculosis requires careful coordination between clinicians, infection prevention, and the county health department. Please contact Infection Prevention at least one day prior to patient discharge to make sure that appropriate follow-up will occur.