Tuberculosis (TB) Guidance

Two primary methods are used to test for TB infection:

• TB Blood Test (IGRA): Preferred for patients who have received the BCG vaccine. A blood sample determines whether a person is infected with TB bacteria.
• TB Skin Test (Mantoux/TST): An acceptable alternative when a blood test is unavailable or cost-prohibitive. Results must be read by a trained provider 48 to 72 hours after administration.

Anyone with symptoms of TB disease or a positive blood or skin test should receive a full medical evaluation, typically including a review of medical history, physical examination, chest X-ray, and sputum specimen collection.

Contact the Washington State Department of Health for information about public health laboratory services available in our area.

General Precautions

• Implement airborne precautions for any patient with suspected or confirmed infectious TB until infectiousness is ruled out or resolved.
• Delay or reschedule nonurgent appointments for patients with suspected or infectious TB.
• Establish cough etiquette throughout your facility. Provide tissues, surgical masks, hand hygiene products, and waste containers in waiting areas.
• Screen patients with a cough lasting more than three weeks and any of the following: blood in sputum, night sweats, unexplained weight loss, or a history of TB disease or exposure.
• If screening is positive, ask the patient to wear a surgical mask, escort them immediately to a private exam room, and implement airborne precautions.
• Do not perform aerosol-inducing procedures or sputum collections unless a negative pressure room or local exhaust ventilation enclosure is available.

Respiratory Protection for Staff

All healthcare personnel entering a shared air space with a suspected or confirmed TB patient should wear a NIOSH-certified, fit-tested N95 respirator or powered air-purifying respirator (PAPR). Surgical masks are for patients in this setting, not providers. Your facility is responsible for maintaining a respiratory protection program that includes medical evaluation, annual fit testing, and staff training.

In a clinic setting:

• Schedule essential appointments at the end of the day to limit exposure to other patients.
• Escort the patient immediately to a private room with negative pressure capabilities if available, and close the door.
• If no negative pressure room is available, consider portable HEPA filtration units. Note: HEPA units do not eliminate the need for staff to wear respiratory protection.
• After the patient leaves, keep the room unoccupied with the door closed until the air has cleared of infectious particles. Consult the CDC guidelines (Table 1) for clearance times based on your room's air exchange rate.

Table 1: Air changes per hour (ACH) and time required for removal efficiencies of 99% and 99.9% of airborne contaminants*

In a hospital setting:

• Keep patients with confirmed or suspected active TB on airborne isolation precautions until active TB disease is ruled out or the patient is deemed noninfectious.
• Work with your infection control practitioner to identify and maintain airborne isolation rooms.
• Limit patient time outside of isolation to medically necessary purposes only.

In long-term care, corrections, or other settings:

• Have a written plan to transfer residents with suspected or infectious TB if no negative pressure room is available.
• If transfer is not immediately possible, place the patient in a temporary holding area where the HVAC system reduces outward airflow, with exhaust flowing directly outdoors.
• Collect sputum specimens in a negative pressure room or outdoors.

Regimens vary based on whether the patient has latent TB infection or active TB disease, drug-susceptibility results, coexisting conditions, and potential drug interactions. Consultation with a TB expert is recommended for complex cases.

CDC recommends Directly Observed Therapy (DOT) as the standard of care for active TB disease. Contact WCPH for help coordinating DOT and connecting patients with support resources.

Patients must complete their full course of treatment. Stopping early or taking medications incorrectly can cause TB to return and may lead to drug resistance, which is significantly harder to treat.

When you report, WCPH will conduct a case investigation, assist with contact identification and follow-up, help coordinate Directly Observed Therapy, provide guidance on isolation and when it may be discontinued, and ensure reporting to the Washington State Department of Health.

DiseasePrevention@whitmancounty.gov | Fax: 509.397.6239 | Business hours: 509.332.6752 | After hours: 509.332.2521