PROCEDURES FOR PATIENTS WITH SUSPECTED OR PROVEN PULMONARY TUBERCULOSIS

All patients suspected of having active infection with MTB must be placed in Airborne Precautions. This entails the following:

1) Place an isolation note for Airborne Precautions in CPRS. This will automatically generate an order; then notify nursing that this order has been placed. This will require transfer of the patient to a negative pressure room.

2) The patient must wear a surgical grade mask when outside of the negative pressure room.

3) Find the Inpatient Order Set “TB Testing Orders” and select “TB Diagnostic Testing”.
    This will generate orders for:

• 2 separate sputum specimens for MTB-PCR (in-house Cepheid™ test that gives same day results if done in the morning)
  and
• 3 separate sputum specimens for AFB smear and culture, taken at least 8 hours apart. These are currently send-out tests and take days for results to return.

4) To take a patient out of Airborne Precautions, or discharge the patient from hospital, there must be 2 negative MTB-PCR results in the chart, and 3 sputum specimens for AFB smear and culture currently collected and pending.  Patients with 2 negative MTB-PCR results are no longer considered to be “TB Suspects.” LA County TB Control does not have to be notified in order to discharge these patients.

5) The ID consult attending may also determine that a patient is not at risk for active TB, and remove the patient from Airborne Precautions. The patient may then be discharged without consulting LA County TB Control.

6) When planning to discharge patients who are suspected of having active MTB (either MTB-PCR positive and/or culture positive), please call Infection Control to help coordinate the discharge.

• These patients require written approval from LA County TB Control prior to discharge and an appointment for follow up in a County TB Control Clinic. Infection Control will ensure that the patient is given an appointment within the week in one of the County TB Clinics.
• You must provide these patients with their appointments and a one week supply of their TB medications at the time of discharge.