D. Patient Management
If the patient has been identified as having active tuberculosis disease, initiation of therapy should
be prompt using the most current CDC guidelines.
After a patient has been identified as having S/KI TB, the patient should be placed in a room meeting the
engineering control guidelines noted below in this document. Enablers may be necessary to assure that
the patient remains in this controlled environment, since patients cannot be allowed to wander about the
hospital in an unprotected manner. Enablers, such a-s television sets, telephones, bathing facilities, and
recreational activities may be important to maintain these precautionary measures. In order to maintain
proper directional air flow in the rooms, the doors must remain closed. If the patient must be out of the
room for clinical purposes, the patient should wear a surgical mask and administrative arrangements
made to expedite the return of the patient to the negative pressure room. Discharge and follow-up
planning should be initiated as soon as possible in order to assure seamless transition between the hospital
setting and outpatient care. This will likely involve the VHA outpatient clinic system and the
governmental health department from which the patient may receive follow-up. As part of this process,
immediate reporting of tuberculosis patients to the health department consistent with VA rules and
regulations is necessary.
E. Visitors
Visitors to patients who have S/KI TB should be given respirators to wear while in the isolation rooms,
and they should be given general instructions on how to use their respirators (CDC Guidelines MMWR,
October 28, 1994, Vol. 43, No.RR- 13, p28).
F. Discontinuation of AFB Precautions
The following criteria must be used for discontinuing precautions for patients in the Medical Center with
S/KI TB:
1.
The patient is found not to have tuberculosior
s
2.
The patient is on appropriate therapy; (it should be noted that appropriate therapy
needs to be defined at the local level based on community incidence of multi-drug
resistant tuberculosis, tuberculosis susceptibility testing of facility isolates, and the
specific known susceptibilities of the patient's organismnd A positive clinical
a)
response to therapyand Three consecutive negative A.FB smears collected on separate
days
IV.
Engineering Controls
A. General Guidelines
The CDC guidelines are the minimum acceptable level, and should be increased where required to satisfy
other mandated criteria or engineering requirements. Where current VA criteria exceed the CDC
guidance, the use of VA criteria is recommended. However, if existing configuration or cost do not allow
compliance to more stringent VA criteria, then the CDC guidance is the minimum acceptable.
4
Previous Page
