[Table of Contents]

Volume: 22S1 • April 1996

Guidelines for Preventing the Transmission of Tuberculosis in Canadian Health Care Facilities and Other Institutional Settings

IV. TB MANAGEMENT PROGRAM

J. Action Summary

The level of risk calculated from the "Health Care Facility Risk" and the "Activity Risk" assessment should be used, where appropriate, by those responsible for the TB management program to help determine the organization-specific policies, procedures and resources required to manage patients with active TB within the health care facility and to establish appropriate HCW screening and surveillance programs.

The following summarizes information presented in other sections of this document and indicates how the risk assessment may be used to help determine the needs indicated above. The requirements are not static and may change with the periodic re-assessment of the health care facility and activity risk.

The summary outlines the required actions related to the following:

• the TB management program;
• personnel with expertise in managing patients with active TB;
• ventilation;
• number and type of isolation rooms;
• masks; and
• HCW screening and surveillance program.

TB Management Program

All health care facilities, whether at high or low risk for the transmission of TB, must have a TB management program that is reviewed at least annually (see Section IV).

Personnel with Expertise in Managing Individuals with Active TB

Health care facilities should have access to consultation from a physician from respiratory medicine, infectious diseases or public health who has expertise in the management of TB.

Health Care Facility Risk

Ventilation

Ventilation requirements for high-risk procedure rooms, such as bronchoscopy suites, and for isolation rooms are indicated below (see Section IV.E).

Number and Type of Isolation Rooms

The number of general isolation rooms, as well as the number required in emergency departments and intensive care units, is indicated below (see Section IV.E).

Masks

At this time, recommendations for the use of masks cannot be determined by the assessment of health care facility risk as high or low or by the assessment of activity risk as high, intermediate or low (see Section IV.F).

Insufficient epidemiologic data exists to definitively recommend specific masks at this time. Based on theoretic considerations masks should

• filter particles >or= one micron (infectious TB particles are one to five microns in size);
• have a 95% filter efficiency, tested in the unloaded state; and
• provide a tight facial seal (less than 10% facial seal leak).

• caring for a patient with suspected or confirmed infectious TB;
• entering a room where a patient with suspected or confirmed infectious TB is being isolated;
• present with a patient with suspected or confirmed infectious TB is undergoing a procedure that is likely to produce aerosolized infectious particles or to result in coughing or copious sputum production, even if appropriate ventilation is in place;
• in contact with a patient with signs and symptoms that suggest infectious TB (e.g., during ambulance transport or transport in protective custody);
• performing an autopsy (see Section VI).

HCW Screening and Surveillance

Health care facilities should have a baseline TB infection status recorded for all HCWs. For new employees, TB infection status should be determined prior to placement.

The following table indicates the recommended frequency of ongoing HCW TB screening based on the health care facility risk and activity risk (see Section IV.C).

NOTES: (refer to Section IV.B)

1. High-risk activities include activities of personnel who are involved
   with cough-inducing procedures, autopsy, morbid anatomy and pathology
   examinations, bronchoscopy and designated mycobacterium laboratory
   procedures.

2. Intermediate-risk activities include activities of personnel who have
   regular direct patient contact and work on units with patients active
   TB (all personnel, including housekeepers, clerks and maintenance staff).

3. Low-risk activities include activities of personnel who have minimal
   patient contact (e.g., working in medical records, administration) or
   regular patient contact but rarely with patients with TB (e.g., obstetrics,
   gynecology, neonatal intensive care unit).

4. See Section IV.D.7.

[Previous] [Table of Contents] [Next]