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 for Mycobacterium tuberculosis, the following is appropriate:
a. First isolate
b. Additional isolates if
(I) failure to convert cultures within three months of beginning therapy
(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 tuberulosis 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.
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 as 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.
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