CDC guidelines for TB prevention
Atriage of patients in emergency departments (EDs) and other ambulatory settings should include vigorous efforts to promptly identify patients who have active tuberculosis, the Centers for Disease Control and Prevention recommends.1 CDC guidelines for preventing TB transmission in the ED are summarized as follows:
• Health care workers who are the first points of contact in facilities that serve populations at risk for TB should be trained to ask questions that will facilitate identification of patients with signs and symptoms suggestive of TB.
• A diagnosis of TB may be considered for any patient who has a persistent cough (i.e., a cough lasting for greater than or equal to three weeks) or other signs or symptoms compatible with active TB (e.g., bloody sputum, night sweats, weight loss, anorexia, or fever).
• However, the index of suspicion for TB will vary in different geographic areas and will depend on the prevalence of TB and other characteristics of the population served by the facility. The index of suspicion for TB should be very high in geographic areas or among groups of patients in which the prevalence of TB is high.
• Patients with signs or symptoms suggestive of TB should be evaluated promptly to minimize the amount of time they are in ambulatory-care areas. TB precautions should be followed while the diagnostic evaluation is being conducted for these patients.
• TB precautions in the ED should include placing these patients in a separate area apart from other patients and not in open waiting areas. (Ideally, they should be placed in a room or enclosure meeting TB isolation requirements.) Give TB patients surgical masks to wear, and instruct them to keep their masks on. In addition, give the patients tissues and instruct them to cover their mouths and noses with the tissues when coughing or sneezing.
• Ventilation in ambulatory care areas where patients at high risk for TB are treated should be designed and maintained to reduce the risk of transmission. Enhanced general ventilation or the use of air-disinfection techniques (e.g., ultraviolet radiation lights or recirculation of air within the room through high-efficiency particulate air [HEPA] filters may be useful in general-use areas of facilities where many infectious TB patients receive care.)
Reference
1. Centers for Disease Control and Prevention. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health care facilities, 1994. MMWR 1994; 43:(No. RR-13)1-133.
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