From the Guidelines
Yes, patients with military tuberculosis (TB) require aerosol isolation and negative pressure rooms. Military TB is a severe form of disseminated tuberculosis where the Mycobacterium tuberculosis bacteria have spread through the bloodstream to multiple organs, and it is highly contagious through airborne transmission. These patients should be placed in airborne infection isolation rooms (AIIRs) with negative pressure ventilation that exhausts air outside or through HEPA filtration before recirculation, as recommended by the Centers for Disease Control and Prevention 1. Healthcare workers must wear N95 respirators or higher-level respiratory protection when entering these rooms.
Key Considerations
- Isolation should continue until the patient has received effective TB therapy for at least 2 weeks, shows clinical improvement, and has three consecutive negative sputum smears collected on different days.
- The World Health Organization (WHO) guidelines suggest that smear-positive TB patients do not necessarily need isolation in negative pressure rooms in a hospital, but culture-positive extensively drug-resistant TB (XDR-TB) patients should be in respiratory isolation at all times 1.
- The use of negative pressure rooms is crucial in preventing the transmission of TB, especially in healthcare settings, as it helps to minimize the spread of infectious droplet nuclei into the general healthcare setting 1.
- The direction of air flow should be monitored while the room is being used for AFB isolation, and the use of flutter strips or smoke tubes can help determine the direction of air flow 1.
Infection Control Measures
- Patients with military TB should be instructed to cover their nose and mouth with a tissue during coughing and sneezing, and should wear a properly fitted surgical mask or valveless respirator if they must leave the room 1.
- Healthcare workers should wear personal protective equipment, including N95 respirators, when entering the patient's room, and should follow proper hand hygiene and infection control procedures.
- The patient's room should be cleaned and disinfected regularly, and any equipment or supplies that come into contact with the patient should be properly sterilized or disinfected. According to the most recent and highest quality study available 1, the balance between patient harms and healthcare costs from unnecessary isolation, and the safety of healthcare staff and the wider community, should be carefully considered when determining the need for isolation. However, given the highly infectious nature of military TB, strict isolation measures are necessary to prevent transmission and protect public health.
From the Research
Patients with Military TB and Aerosol Isolation
- The provided studies do not directly address the question of whether patients with military TB require aerosol isolation and negative pressure 2, 3, 4, 5.
- However, a study on the control and prevention of healthcare-associated tuberculosis suggests that negative pressure isolation rooms and personal respiratory protection can be effective in preventing the transmission of TB 6.
- The study recommends that these measures be taken for all patients with suspected or confirmed tuberculosis, as multi-drug resistant TB may not always be apparent on admission 6.
- The use of negative pressure isolation rooms and personal respiratory protection can minimize the transmission of TB to other patients and healthcare staff 6.
Key Considerations
- The absence of clinical trials in this area precludes dogmatic recommendations 6.
- Observational studies and mathematical modeling suggest that all measures, including administrative, engineering, and personal respiratory protection, are required for effective prevention 6.
- Regular review and audit of policies and facilities are necessary to ensure optimal compliance 6.