Page 17 - Delaware Medical Journal - March/April 2020
P. 17
PUBLIC HEALTH
WHAT TO DO IF YOU SUSPECT TB
1. Implement AII precautions immediately and do not discontinue ruled out. Details on AII precautions can be found in the CDC’s Morbidity and Mortality Weekly Report (MMWR) publication, Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005.9
For facilities without an AII room:
■ Put a surgical mask on the patient and an N95 mask on all staff interacting with him/her.
■ Isolate the patient in a room with effective general ventilation. After
the patient exits, allow adequate time
to elapse to ensure removal of M. tuberculosis-contaminated air from the room before allowing others to enter.
This may mean waiting up to three hours depending on equivalent air changes per hour (ACH); see the MMWR’s Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health- Care Settings, 20059 and Table 1 for details.
■ Air-cleaning technologies (e.g., high- and ultraviolet germicidal irradiation) can be used to increase ACH in waiting areas.9
2. Begin testing for TB by administering a TST or IGRA.
Currently two IGRAs are commercially available in the U.S.: the QuantiFERON®- TB Gold Plus and the T-SPOT®TB test. The IGRAs are the preferred TB tests, especially in non-U.S. born individuals.
If using the TST, there are three
risk factors; it is important to interpret the results based on the patient’s risk assessment. In those who are severely immunocompromised, a negative TB test does not exclude the possibility of TB infection or disease.
3. Obtain a chest x-ray to evaluate for signs of active disease.
4. Get a sputum sample for acid- fast bacilli (AFB) smear, nucleic acid
If a sputum sample cannot be produced, perform an induced sputum. In children, gastric aspirate may be used.
Do not perform a bronchoscopy unless all other means of obtaining a specimen have failed. An induced sputum has similar
diagnostic yield as a bronchoscopy and poses less risk of exposure to aerosolized secretions for health care personnel.10
5. Consider consultation with an infectious disease expert.
6. Per Delaware code, report the
disease to DPH within two working days.
When reporting, contact the TB clinic
in the county where the patient resides. To report a case in New Castle County, call 302-283-7588; in Kent County, call 302-857-5130; and in Sussex County, call 302-515-3200.Although it is not required, DPH encourages reporting cases of LTBI, enabling those individuals to be offered treatment to prevent progression to TB disease.
Del Med J | March/April 2020 | Vol. 92 | No. 2
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