CDC issues updated TB prevention guidelines

The Atlanta, GA-based Centers for Disease Control and Prevention has issued updated guidelines for preventing the transmission of tuberculosis in health care settings.

The report, "Guidelines for Preventing the Transmission of Mycobacterium Tuberculosis in Health-Care Settings," updates recommendations issued in 1994 to reflect shifts in the epidemiology of the disease, advances in scientific understanding, and changes in health care practice.

The guidelines note that TB transmission in health care settings continues to decrease due to implementation of infection-control measures and reductions in community rates of TB.

The report replaces the 1994 guidelines for Mycobacterium tuberculosis (TB) prevention and subsequent TB updates that focused on specific health care facilities. Prepared in consultation with experts in TB, infection control, environmental control, respiratory protection, and occupational health, the new guidelines encompass more health care settings having the potential for TB transmission than in the past guidelines.

Health care settings

"The 1994 CDC guidelines were aimed primarily at hospital-based facilities, which frequently refer to a physical building or set of buildings. The 2005 guidelines have been expanded to address a broader concept. Setting’ has been chosen instead of facility’ to expand the scope of potential places for which these guidelines apply," the introduction to the report explains.

The new guidelines apply to the following health care settings:

  • Inpatient settings: patient rooms, emergency departments, intensive care units, surgical suites, laboratories, laboratory procedure areas, bronchoscopy suites, sputum induction or inhalation therapy rooms, autopsy suites, and embalming rooms.
  • Outpatient settings: TB treatment facilities, medical offices, ambulatory care settings, dialysis units, and dental care settings.
  • Nontraditional facility-based settings: emergency medical service, medical settings in correctional facilities, home-based health care and outreach settings, long-term care settings (e.g., hospice-skilled nursing facilities), and homeless shelters.

Other settings in which suspected and confirmed TB patients might be encountered include cafeterias, general stores, kitchens, laundry areas, maintenance shops, pharmacies, and law enforcement settings.

Additional changes differentiating the new guidelines from previous reports are:

  • Using more aspects of infection control in assessing risk levels for a health care setting.
  • Replacing purified protein derivative tests with the term "tuberculin skin tests."
  • Recognizing blood tests as alternatives to TSTs in TB screening programs for health care workers.
  • Changing the criteria for and decreasing the frequency of TB screenings for health care workers in certain settings.
  • Clearly defining the criteria for serial testing for TB infection of health care workers.
  • Introducing the terms airborne infection precautions and airborne infection isolation room.
  • Making recommendations for annual respirator training, initial respirator fit testing, and periodic respirator fit testing.
  • Summarizing the evidence for respirator fit testing.
  • Including information on ultraviolet germicidal irradiation and expanding on room-air recirculation units.
  • Adding information on multi-drug-resistant TB and HIV infection.