What type of isolation is required for Tuberculosis (TB)?

From the Guidelines

Tuberculosis (TB) requires airborne isolation precautions for patients with suspected or confirmed infectious TB disease, and the most recent guidelines suggest that patients should be placed in a negative pressure room with at least six air exchanges per hour, with air exhausted directly outside or through HEPA filtration, as recommended by the World Health Organization (WHO) and supported by studies such as 1. Patients with TB should be isolated in a single-patient room with negative pressure relative to the corridor or other areas connected to the room, as stated in 1. The room's openings, such as windows and electrical and plumbing entries, should be sealed as much as possible, with a small gap of 1/8 to 1/2 inch at the bottom of the door to provide a controlled airflow path, as recommended in 1. Healthcare workers and visitors must wear personal respiratory protection, such as N95 respirators or higher-level protection, when entering the room, as stated in 1. Isolation should continue until the patient has three consecutive negative sputum smears collected on different days, has received effective TB treatment for at least 2 weeks, and shows clinical improvement, as suggested by 1 and 1. For drug-resistant TB, especially multidrug-resistant (MDR) or extensively drug-resistant (XDR) TB, isolation may need to continue longer until cultures become negative, as noted in 1 and 1. The strict airborne precautions are necessary because TB spreads through microscopic droplet nuclei that remain suspended in the air for extended periods and can be inhaled by susceptible individuals, as explained in 1 and 1. Proper isolation prevents transmission to healthcare workers, other patients, and visitors while allowing the infected individual to receive appropriate treatment, as emphasized in 1, 1, and 1.

Some key points to consider when implementing isolation precautions for TB patients include:

• Using negative pressure rooms with controlled airflow to prevent the spread of infectious droplet nuclei, as recommended in 1 and 1
• Ensuring that healthcare workers and visitors wear personal respiratory protection, such as N95 respirators, when entering the room, as stated in 1
• Implementing administrative and environmental controls, such as triage, separation of infectious cases, and minimization of the time spent at the health facility, as suggested in 1
• Considering the use of molecular diagnostic techniques to rapidly identify drug-resistant TB and guide treatment decisions, as noted in 1 and 1
• Balancing the need for isolation with the potential harms and healthcare costs associated with unnecessary isolation, as discussed in 1 and 1.

Overall, the key to effective isolation precautions for TB patients is to strike a balance between preventing transmission and minimizing harm to the patient, while also ensuring that healthcare workers and visitors are protected from infection, as emphasized in 1, 1, and 1.

From the Research

Isolation Requirements for TB

• TB requires respiratory isolation to prevent the spread of the disease to others, particularly in healthcare settings 2.
• The Centers for Disease Control and Prevention (CDC) recommends airborne isolation for patients with suspected pulmonary tuberculosis (PTB) 3.
• Negative pressure isolation rooms are recommended for patients with suspected multi-drug resistant TB, and personal respiratory protection (e.g. face sealing masks) is advised for healthcare workers entering the room of a patient with suspected or confirmed tuberculosis 2.

Types of Isolation

• Airborne isolation: used to prevent the spread of airborne pathogens, such as TB, and requires a negative pressure isolation room and personal respiratory protection 2, 3.
• Respiratory isolation: used to prevent the spread of respiratory pathogens, such as TB, and may involve the use of face masks and other personal protective equipment 3.

Duration of Isolation

• The duration of isolation for TB patients depends on various factors, including the severity of the disease, the effectiveness of treatment, and the presence of multidrug-resistant TB 4, 5.
• Patients with TB may need to be isolated for several weeks or even months to prevent the spread of the disease to others 4, 5.

Hospital Practices

• Hospitalized persons with suspected pulmonary tuberculosis (PTB) are often placed in airborne isolation to prevent nosocomial infection 3.
• However, clinicians may overuse this resource due to an abundance of caution, leading to unnecessary isolation of patients without PTB 3.
• Predictive tools based on clinical and radiographic data can assist clinicians in deciding which patients to place in respiratory isolation, potentially reducing unnecessary isolation days 3.