Prevention and Control of Tuberculosis in Correctional and Detention Facilities: Recommendations from CDC

Endorsed by the Advisory Council for the Elimination of Tuberculosis, the National Commission on Correctional Health Care, and the American Correctional Association

Disclosures

Morbidity and Mortality Weekly Report. 2006;55(27):1-44. 

In This Article

Isolation in an Airborne Infection Isolation Room

TB airborne precautions should be initiated for any patient who has signs or symptoms of TB disease or who has documented TB disease and has not completed treatment or not been determined previously to be noninfectious.

For patients placed in an AII room because of suspected infectious TB disease of the lungs, airways, or larynx, airborne precautions can be discontinued when infectious TB disease is considered unlikely and either 1) another diagnosis is made that explains the clinical syndrome or 2) the patient has three negative acid-fast bacilli (AFB) sputum-smear results.[67,68] The three sputum specimens should be collected 8--24 hours apart,[69] and at least one should be an early morning specimen (because respiratory secretions pool overnight). Typically, this will allow patients with negative sputum-smear results to be released from an AII room in 2 days. Incarcerated patients for whom the suspicion of TB disease remains after the collection of three negative AFB sputum-smear results should not be released from airborne precautions until they are on standard multidrug anti-TB treatment and are clinically improving. Because patients with TB disease who have negative AFB sputum-smear results can still be infectious,[70] patients with suspected disease who meet the above criteria for release from airborne precautions should not be released to an area in which other patients with immunocompromising conditions are housed.

A patient who has drug-susceptible TB of the lung, airways, or larynx, is on standard multidrug anti-TB treatment, and has had a significant clinical and bacteriologic response to therapy (i.e., reduction in cough, resolution of fever, and progressively decreasing quantity of AFB on smear result) is probably no longer infectious. However, because culture and drug-susceptibility results are not typically known when the decision to discontinue airborne precautions is made, all patients with confirmed TB disease should remain in an AII room while incarcerated until they

  • have had three consecutive negative AFB sputum-smear results collected 8--24 hours apart, with at least one being an early morning specimen,

  • have received standard multidrug anti-TB treatment, and

  • have demonstrated clinical improvement.

Because the consequences of transmission of MDR TB (i.e., TB that is resistant to isoniazid and rifampin) are severe, infection-control practitioners might choose to keep persons with suspected or confirmed MDR TB disease in an AII room until negative sputum-culture results have been documented in addition to negative AFB sputum-smear results.

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