Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska
Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska
When to Discontinue Airborne Infection Isolation A L A S K A T U B E R C U L O S I S P R O G R A M M A N U A L INFECTION CONTROL 17.20 Revised November 2012 Prior to discontinuing isolation, call the Infection Preventionist. High-risk patients should be carefully evaluated before discontinuing isolation. Hospitalized patients with suspected or confirmed MDR-TB should remain in an AII room throughout their hospitalization. Suspected Tuberculosis Disease For patients placed in AII due to suspected infectious TB disease of the lungs, airway, or larynx, AII can be discontinued when the criteria in Table 7 are met. Table 7: DISCONTINUATION OF AIRBORNE INFECTION ISOLATION OF SUSPECTED CASES OF TUBERCULOSIS 36 Criteria for Discontinuing Airborne Infection Isolation: Suspected Case of Tuberculosis of the Lungs, Airway, or Larynx Infectious tuberculosis (TB) disease is considered unlikely AND Either Another diagnosis is made that explains the clinical syndrome OR The patient has 3 negative acid-fast bacilli (AFB) sputum smear results* has been on treatment delivered as directly observed therapy for al least 2 weeks, and has demonstrated clinical improvement * Each of the 3 sputum specimens should be collected 8 to 24 hours apart, and at least 1 should be an early morning specimen (because respiratory secretions pool overnight). Generally, this will allow patients with negative AFB sputum smear results to be released from AII in 2 days. 37 While in the hospital for any reason, patients with pulmonary TB should remain in airborne infection isolation until they (1) are receiving standard multidrug antituberculosis therapy; (2) have demonstrated clinical improvement; and (3) have had 3 consecutive AFB-negative smear results of sputum specimens collected 8 to 24 hours apart, with at least 1 being an early morning specimen. 38 Because patients with TB disease who have negative AFB sputum smear results can still be infectious, patients with suspected disease who meet the above criteria for release from AII should not be released to an area where other patients with immunocompromising conditions or children
Confirmed Tuberculosis Disease A patient with drug-susceptible TB of the lung, airway, or larynx who is on standard multidrug antituberculosis treatment and who has had a significant clinical and bacteriologic response to therapy (e.g., reduction in cough, resolution of fever, and progressively decreasing quantities of AFB on smear results) is probably no longer infectious. However, because culture and drug susceptibility results are not usually known when the decision to discontinue AII is made, all patients with confirmed TB disease should remain in AII while hospitalized until all the criteria in Table 8 are met. 40 Table 8: DISCONTINUATION OF AIRBORNE INFECTION ISOLATION OF CONFIRMED CASES OF TUBERCULOSIS 41 Criteria for Discontinuing Airborne Infection Isolation: Hospitalized Patients with Confirmed, Drug-Susceptible Tuberculosis of the Lungs, Airway, or Larynx The patient has had 3 consecutive negative acid-fast bacilli (AFB) sputum smear results collected 8 to 24 hours apart, with at least 1 being an early morning specimen AND The patient has received at least 2 weeks of standard multidrug antituberculosis treatment by directly observed therapy (DOT) AND The patient has demonstrated clinical improvement Source: CDC. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care settings, 2005. MMWR 2005;54(No. RR-17):43. A L A S K A T U B E R C U L O S I S P R O G R A M M A N U A L INFECTION CONTROL 17.21 Revised November 2012
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When to Discontinue Airborne Infection Isolation<br />
A L A S K A T U B E R C U L O S I S P R O G R A M M A N U A L INFECTION CONTROL 17.20<br />
Revised November 2012<br />
Prior to discontinuing isolation, call the Infection Preventionist. High-risk<br />
patients should be carefully evaluated before discontinuing isolation.<br />
Hospitalized patients with suspected or confirmed MDR-TB should remain<br />
in an AII room throughout their hospitalization.<br />
Suspected <strong>Tuberculosis</strong> Disease<br />
For patients placed in AII due to suspected infectious TB disease <strong>of</strong> the lungs, airway, or<br />
larynx, AII can be discontinued when the criteria in Table 7 are met.<br />
Table 7: DISCONTINUATION OF AIRBORNE INFECTION ISOLATION OF SUSPECTED<br />
CASES OF TUBERCULOSIS 36<br />
Criteria for Discontinuing Airborne Infection Isolation:<br />
Suspected Case <strong>of</strong> <strong>Tuberculosis</strong> <strong>of</strong> the Lungs, Airway, or Larynx<br />
Infectious tuberculosis (TB) disease is<br />
considered unlikely<br />
AND Either<br />
Another diagnosis is made that explains the<br />
clinical syndrome<br />
OR<br />
The patient has 3 negative acid-fast bacilli (AFB)<br />
sputum smear results* has been on treatment<br />
delivered as directly observed therapy for al least<br />
2 weeks, and has demonstrated clinical<br />
improvement<br />
* Each <strong>of</strong> the 3 sputum specimens should be collected 8 to 24 hours apart, and at least 1 should be an early morning specimen<br />
(because respiratory secretions pool overnight). Generally, this will allow patients with negative AFB sputum smear results to<br />
be released from AII in 2 days. 37<br />
While in the hospital for any reason, patients with pulmonary TB should remain in airborne infection isolation until they<br />
(1) are receiving standard multidrug antituberculosis therapy; (2) have demonstrated clinical improvement; and (3) have<br />
had 3 consecutive AFB-negative smear results <strong>of</strong> sputum specimens collected 8 to 24 hours apart, with at least 1 being an<br />
early morning specimen. 38<br />
Because patients with TB disease who have negative AFB sputum smear results can still be infectious, patients with<br />
suspected disease who meet the above criteria for release from AII should not be released to an area where other patients<br />
with immunocompromising conditions or children
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