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Tuberculosis SUMMARY
Updated 11/03
For more information, please visit the Johns Hopkins Center for Tuberculosis Research or see our article "Tuberculosis"

Introduction

Tuberculosis (TB) control measures are intended for all patients with potentially transmissible laryngeal or pulmonary TB and TB in the oral cavity. The specific category for isolating patients is Airborne Isolation. Persons without evidence of active pulmonary TB (e.g., persons with only positive PPD skin test or with old calcified lung lesions) or patients that have completed adequate treatment for pulmonary/laryngeal TB (>14 days of anti-TB therapy and clinical response) do not require isolation.

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Responsibilities

Department of Hospital Epidemiology and Infection Control (HEIC) will educate staff about TB and Airborne Isolation, investigate all active TB cases, generate line lists of cases and exposures, coordinate employee exposure follow-up with OHS, work with Mircobiology Lab to identify all active TB in the hospital.

Clinical and Support Personnel must follow the requirements of this policy.

Supervisor/Managers of all Departments must ensure employee compliance with this policy.

Adult/Pediatric Infectious Disease Fellows must approve patients being placed in Airborne Precautions.

Health, Safety, and Environment will maintain portable HEPA units and PAPR’s and assist with questions and training concerning their use, operation, and repair.

Centrtal Supply Department will distribute PAPRs and HEPA units and maintain adaquate supplies at all times.

Facilities must document the routine and special monitoring and maintenance of the Airborne ventilation systems and Isolation rooms.

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Prevent Exposures

Use Negative Pressure Isolation Rooms
Negative Pressure Rooms, designed as Airborne Isolation rooms, should be used as soon as patients are identified as requiring Airborne Precautions. List of Negative Pressure Rooms

Close the Door
The doors to these patients rooms must be closed at all times except for entering and exiting. Outpatients thought to have TB shall be placed in a private room with the door closed. Time spent in waiting areas must be limited. If a designated Airborne Isolation room is not available, a portable HEPA filter must be placed near the door of the patient room.

Wear a Protective Respiratory Device
All healthcare workers entering the room must wear an approved respirator. The Positive Air Pressure Respirator (PAPR) is the HEPA respirator of choice at JHH. Only respirator trained essential healthcare personnel should enter the Airborne Isolation room.

Protection before Procedures
Prior to performing cough-inducing procedures on a patient, (e.g. CT Guided lung biopsy), the patient's chest x-ray should be assessed for TB. Health care workers involved with procedures on patients with suspected or active TB shall wear PAPR's. No surgical procedures can be performed in the Outpatient Center on suspected or active cases of TB.

Necessary Transport Only
Notify the accepting unit prior to the patient's arrival for necessary medical procedures that cannot be performed in the Airborne Isolation room. Have the patient wear a surgical mask, and attempt to clear the area of other patients and visitors.

Limit Visitors
Visitation to patients in Airborne Precautions should be limited. Children should not visit patients in Airborne Precautions.

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Discontinuing Isolation

To discontinue Airborne Precautions on patients only suspected of having TB (no positive AFB smear or cultures):

  Three AFB smear negative expectorated sputums from different days
OR One AFB smear negative induced sputum
OR One AFB smear negative sputum obtained from brochoscopy
OR One AFB shear negative sputum obtained from an endotracheal tube or tracheotomy
OR Three AFB smear negative gastric aspirates obtained on different days from pediatric patients
 

To discontinue Airborne Precautions on patients who are AFB smear positive:

  If MDR-TB is not suspected, isolation may be discontinued if there has been adequate response (defined as resolution or improvement of both respiratory symptoms and fever) to 14 days of emperic therapy with four drugs. Incidences when the patient has a known positive MOTT culture within the recent past and no CXR changes must be discussed with the HEIC/ID before discontinuing the isolation.
  If MDR-TB is suspected, continue Airborne Precautions during adequate, multiple drug therapy until there is clinical improvement. The patient must receive at least 14 days of therapy and at least 3 negative AFB smears or 3 negative gastric aspirates or one adequate bronchoscopy or induced sputum specimen.

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