Criteria for Discontinuing Airborne Precautions for TB

Section 7: Management of TB

Food and Nutrition

Disposable dishware and trays are not required for patients on airborne precautions. Food service personnel are not to enter patient's room. Nursing staff will deliver and remove meal trays and nourishments to patient's room. In the rare event that dishes, utensils, or food trays are contaminated with blood or body drainage, return the items to Central Supply Room (CSR) for reprocessing, using the following procedure: ? Place the items in a designated container ? Place in a biohazard red container, and take to CSR for reprocessing

Criteria for Discontinuing Airborne Precautions for TB

The Internal Medicine Specialist, Chief Public Health Officer, or the Infection Control Practitioner, may terminate airborne precautions when the following criteria for discontinuation of airborne precautions have been met:

Suspect TB Cases

A patient admitted for suspect TB will remain on airborne isolation until: ? Three successive sputum specimens (spontaneous or induced) are negative on smear unless

TB is still strongly suspected and no other diagnosis has been made. Note: Specimens can be collected within 1 hour of each other on the same day, and early morning collection is not considered necessary, but is optimal to yield better sensitivity. In patients who are no longer able to spontaneously produce a sputum specimen, sputum induction is useful and appropriate.

Confirmed TB Cases

Although the degree and duration of infectiousness of patients after initiation of effective therapy remains unclear, it is known that effective therapy (i.e. therapy with two or more drugs to which the TB organisms are susceptible) will rapidly reduce cough and the number of viable bacteria in the sputum. Note: DST results are usually available within 3 weeks in either a smear-negative, culturepositive case or a smear-positive case and these susceptibilities will confirm the effectiveness of therapy. ? A patient admitted for active TB determined to be culture positive but of confirmed

negative smear status will remain on airborne precautions until: - Completion of minimum 14 days of daily anti-tuberculosis therapy by Directly Observed Treatment (DOT) - Three successive sputum specimens (spontaneous or induced) are negative on smear - There is evidence of clinical improvement

NWT TNuWbeTrcTulboesriscuMloasnisuMal a- nNuoavle-mJubneer 2014 7-13

Section 7: Management of TB

? A patient who is admitted for active TB determined to be smear and culture positive will remain on airborne precautions until:

- Completion of minimum 14 days of daily anti-tuberculosis therapy by DOT; and - Three successive sputum specimens (spontaneous or induced) are negative on smear; and - There is clinical evidence of improvement and - Drug susceptibilities are known and drug resistance is ruled out - After 14 days of daily treatment if sputum specimens are still smear positive, the patient

must remain in airborne isolation until three successive sputum specimens (spontaneous or induced) are negative on smear on three separate days - Patients known to have active multidrug-resistant TB or mono-resistance to rifampin: These patients should be kept under airborne precautions for the duration of their hospital stay or until three consecutive sputum cultures (not smears) are negative after 6 weeks of incubation.

Discontinuation of isolation precautions should NEVER be based on a fixed interval of treatment (e.g. 2 weeks) but, rather, on evidence of clinical and bacteriologic improvement and evidence of the adequacy of the treatment regimes. In summary, isolation precautions should be continued until patients are highly likely to be non-infectious.

See Section 8, Treatment for Tuberculosis, for further details.

Direct Observed Treatment (DOT)

Nursing staff are responsible for Directly Observed Treatment (DOT) of the patient's anti-TB medications, which includes: ? documentation of directly observing ingestion of the medications; OR ? documentation and reporting of any refused doses. Refused or missed doses must be

reported immediately to the OCPHO and IM specialist.

? See Section 8, Treatment for Tuberculosis, for more details on DOT.

Discharge Planning

Prior to discharging a patient back to his or her home community, it is imperative to assess for any social issues that may limit adherence to the long-term TB treatment. Referrals for alcohol or drug rehabilitation programs or social incentives such as food vouchers or taxi tickets needed to assist with adherence, may need consideration.

Discharge planning should include a referral to social services if indicated.

It is also imperative that there is sufficient capacity at the local health clinic to provide DOT on a daily or thrice weekly basis depending on the recommendation of treatment. Failure to deal with these issues at the initial admission may at times necessitate repeat admissions under Public Health Order requiring 24/7 security. This is a costly endeavor especially to the health care facility which incurs the costs. Regional Health and Social Services Authorities may need to consider added staffing for management of the TB Program and DOT in situations of outbreak or where numerous patients are on DOT.

7-14 NWT Tuberculosis Manual - JNuonveem20b1e4r 2014

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