From the Guidelines
Precautions for tuberculosis (TB) prevention should include instructing patients to cover their mouths and noses with a tissue when coughing or sneezing, and healthcare workers (HCWs) should wear respiratory protection when entering the homes of patients with suspected or confirmed infectious TB. This approach is based on guidelines from the Centers for Disease Control and Prevention (CDC) and is supported by studies such as 1 and 1.
Key Precautions
- Instructing patients to cover coughs and sneezes with a tissue
- HCWs wearing respiratory protection when entering the homes of patients with suspected or confirmed infectious TB
- Considering temporary relocation of immunocompromised persons or young children living in the home with a patient who has infectious pulmonary or laryngeal tuberculosis until the patient has negative sputum smears
- Administering cough-inducing procedures in a well-ventilated area away from other household members, with persons performing these procedures wearing respiratory protection
Importance of Early Identification and Treatment
Early identification and treatment of persons with tuberculosis is crucial, as highlighted in 1. Home health-care personnel and patients who are at risk for contracting active tuberculosis should be reminded periodically of the importance of having pulmonary symptoms evaluated. Close contacts of any patient with active infectious tuberculosis should be evaluated for tuberculous infection and managed according to CDC and American Thoracic Society guidelines.
Role of Respiratory Protection
The use of respiratory protection (PR) is emphasized in both 1 and 1 for HCWs entering the homes of patients with suspected or confirmed infectious TB, underscoring its importance in preventing the transmission of tuberculosis in healthcare settings.
From the FDA Drug Label
Isoniazid Tablets are recommended as preventive therapy for the following groups, regardless of age Candidates for preventive therapy who have HIV infection should have a minimum of 12 months of therapy. Candidates for preventive therapy who have fibrotic pulmonary lesions consistent with healed tuberculosis or who have pulmonary silicosis should have 12 months of isoniazid or 4 months of isoniazid and rifampin, concomitantly
The recommended precautions for TB prevention include:
- Isoniazid preventive therapy for certain groups, such as those with HIV infection, close contacts of persons with newly diagnosed infectious tuberculosis, and recent converters
- Minimum of 12 months of therapy for HIV-infected persons
- 12 months of isoniazid or 4 months of isoniazid and rifampin for candidates with fibrotic pulmonary lesions or pulmonary silicosis 2
- Tuberculin skin test to determine the need for preventive therapy, with different criteria for different age groups and risk factors
- Close monitoring for the risk of hepatitis in positive tuberculin reactors over the age of 35 2
From the Research
Precautions for Tuberculosis (TB) Prevention
To prevent the spread of tuberculosis (TB), several precautions can be taken, including:
- Administrative controls, such as early recognition of contacts and adoption of efficient protective measures 3, 4
- Environmental controls, such as ventilation systems and isolation rooms 5, 6
- Respiratory protection, such as surgical masks, disposable dust, fume, mist, or disposable high-efficiency particulate air filtering (HEPA) masks, elastomeric HEPA cartridge respirators, and powered air-purifying respirators (PAPRs) 4, 6
- Screening for cases of latent tuberculosis (TL) and recent TL, as well as systematic screening for TB and TL in healthcare workers with contact with patients or other workers with TB and risk of contagion 3
- Personal protection, such as voluntary HIV-testing of health care workers and isoniazid preventive therapy for workers in high-risk settings 5
Recommended Measures
Recommended measures for TB prevention include:
- A three-level hierarchy of administrative, environmental, and respiratory-protection controls 4
- Standard precautions, which provide the fabric for strategies to prevent or reduce the risk of exposure to bloodborne pathogens and other potentially infectious material 4
- A written TB infection-control program, which is essential for oral healthcare settings 4
- Practical and affordable measures, such as diagnosis and treatment of infectious cases, appropriate environmental control, and relevant personal protection and surveillance of health care workers, which are particularly important in low-income countries 5