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)
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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)
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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 )
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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 )
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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 )
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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)
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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)
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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 )
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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 )
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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)
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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)
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Recommendation 5.3
When RIR is implemented, support should be provided to patients to mitigate anticipated and experienced harms. (U, U)
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- 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
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.
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 1, 2024
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.