A. Patient Masks
When any patients are identified as having S/KI TB, they should wear a surgical mask and be placed in
rooms meeting identified engineering controls 'or S/KI TE patients as noted later in this document.
B. Tuberculin Skin Test (TST) for High Risk Patients
Screening for high risk individuals must be a hospital-wide policy. This includes, but is not limited to,
timely ongoing screening of HIV-positive patients, dialysis patients, the homeless, substance abuse
patients and patients in other high risk special programs such as Hospital Based Home Care (HBHC) and
others as identified by the facility. All these screening programs should use the most current CDC-
defined methodology for TST. If a patient has signs or symptoms suggestive of tuberculosis disease, a
full evaluation must be conducted.
C. Laboratory Assessment
It is critical to expedite the evaluation and treatment of patients with S/KI TB. This includes access to
current laboratory technology for acid fast bacteria (AFB) smears, cultures, and susceptibility testing.
1. AFB smears, the following is necessary:
a.
Available five days per week and reported within 24 hours of specimen receipt
b.
Consideration should be given to seven days per week for areas with a high
incidence of TB
c.
One sputum per patient per day should be sufficient
2. Cultures for Mycobacterium tuberculosi,sthe following is needed:
a.
Available five days per week
b.
Rapid identification methodology
Smears and culture results should be reported immediately to designated person(s). This must include the
care provider and should be reported to the Infection control function.
3. Susceptibility testing forMycobacterium tuberculosi,sthe following, is appropriate:
a.
First isolate
b.
Additional isolates if:
(1) failure to convert cultures within three months of beginningethpy
ra
(2) clinical evidence of failure to respond to therapy
(3) other specific circumstances may dictate additional susceptibility testing.
It is not required that all of these activities be done on station. It is the facility's responsibility to assure
that rapid, current diagnostic laboratory testing for Mycobacterium tuberculosis is readily available to
the clinicians. The guidance above should be used as a basis for individual station decision-making
regarding specific time frames and location for each of the studies noted above based on patient care
needs. These decisions should be documented in writing in the facility tuberculosis control plan to ensure
facility-wide consensus by the process stakeholders on these critical clinical testing issues.
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