Respiratory Isolation and Restrictions to Reduce Transmission of Pulmonary Tuberculosis in Community Settings

Publication Date: April 18, 2024
Last Updated: April 22, 2024

Summary of Recommendations

Recommendation 1.1

The decision to recommend TB respiratory isolation and restriction should consider the potential benefits and harm for both the community and the PWTB. (U, U)
620

Recommendation 2.1

Respiratory isolation and restrictions in community settings should be conceptualized as a spectrum of tailored restrictions that are individualized for specific circumstances. (U, U)
620

Recommendation 3.1

Prior to effective treatment initiation, PWTB with higher respiratory bacterial burden (i.e., sputum smear and/or NAAT positivity, cavitation on chest imaging) may be considered as relatively more infectious than those with lower bacterial burden, with individual variability. (S, M )
620

Recommendation 3.2

PWTB on less than five days of effective treatment should be considered relatively more infectious than those on longer durations of effective therapy. (S, M )
620

Recommendation 3.3

PWTB on effective treatment for at least five days should be considered non-infectious or low likelihood of infectiousness, regardless of sputum bacteriologic status during treatment (i.e., smear-microscopy, NAAT or culture status), with certain exceptions. (C, M )
620

Recommendation 3.4

Overall risk of transmission to others should consider both a PWTB’s infectiousness, as well as other factors including the environment of potential exposures, proximity, frequency, and durations of exposure, and biological susceptibility of contacts. (U, U)
620

Recommendation 4.1

RIR is not recommended for persons with non-infectious forms of TB (i.e., localized extrapulmonary TB without pulmonary involvement, as confirmed by sputum bacteriologic studies and/ or chest imaging). (U, U)
620

Recommendation 4.2

People with pulmonary TB on effective treatment and low likelihood of infectiousness should not have restrictions in most circumstances (i.e., RIR should be removed, if present), with individual exceptions for situations involving higher risk community settings and populations (e.g., children < 5, immunosuppressed individuals). (C, M )
620

Recommendation 4.3

Community-based RIR may be considered for PWTB that have higher infectious potential in which there is judged to be higher risk of transmission to the community. (C, L )
620

Recommendation 5.1

When considering restrictions for PWTB, a moderate or midlevel range of RIR should be considered appropriate in most circumstances, with individual exceptions. (U, U)
620

Recommendation 5.2

Specific RIR levels (e.g., low, moderate, or extensive) and duration for PWTB should be reassessed routinely (at least weekly) and may be modified based on individual considerations or changing circumstances. (U, U)
620

Recommendation 5.3

When RIR is implemented, support should be provided to patients to mitigate anticipated and experienced harms. (U, U)
620

Recommendation Grading

Abbreviations

  • AFB: Acid-fast Bacilli
  • ATT: Anti-tuberculosis Therapy
  • CASS: Cough Aerosol Sampling
  • CFU: Colony Forming Units
  • DOT: Directly Observed Therapy
  • DST: Drug Susceptibility Test
  • EBA: Early Bactericidal Activity
  • IGRA: Interferon-gamma Release Assay
  • NAAT: Nucleic Acid Amplification Test
  • NTCA: National Tuberculosis Coalition Of America
  • PAS: Para-amino Salicylic Acid
  • PWTB: Person Or Persons With TB
  • RIR: Respiratory Isolation And Restriction
  • TB: Tuberculosis
  • TST: Tuberculin Skin Test

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.

Overview

Title

Respiratory Isolation and Restrictions to Reduce Transmission of Pulmonary Tuberculosis in Community Settings

Authoring Organization

National Tuberculosis Coalition of America

Publication Month/Year

April 18, 2024

Last Updated Month/Year

May 29, 2024

Document Type

Guideline

Country of Publication

US

Inclusion Criteria

Male, Female, Adult, Older adult

Health Care Settings

Correctional facility, Emergency care, Hospital, Long term care, Operating and recovery room

Intended Users

Nurse, nurse practitioner, physician, physician assistant, respiratory therapist

Scope

Management, Prevention

Diseases/Conditions (MeSH)

D014376 - Tuberculosis, D014397 - Tuberculosis, Pulmonary, D010356 - Patient Isolation, D055819 - Hospitals, Isolation

Keywords

isolation, Isolation Precautions, TB, pulmonary tuberculosis, Tuberculosis

Source Citation

Shah M, Dansky Z, Nathavitharana R, Behm H, Brown S, Dov L, Fortune D, Gadon NL, Gardner Toren K, Graves S, Haley CA, Kates O, Sabuwala N, Wegener D, Yoo K, Burzynski J. NTCA Guidelines for Respiratory Isolation and Restrictions to Reduce Transmission of Pulmonary Tuberculosis in Community Settings. Clin Infect Dis. 2024 Apr 18:ciae199. doi: 10.1093/cid/ciae199. Epub ahead of print. PMID: 38632829.