The Centers for Disease Control and Prevention closed out 2005 by updating its 1994 guidelines for preventing Mycobacterium tuberculosis in health care settings.
The exhaustive guidelines were updated in an effort to respond to “shifts in the epidemiology of TB, advances in scientific understanding, and changes in health care practice that have occurred in the United States during the previous decade,” wrote the authors, led by Paul A. Jensen, Ph.D., in the division of tuberculosis elimination at the CDC's National Center for HIV, STD, and TB Prevention (MMWR 2005;54[RR-17]:1–121).
TB rates have declined in recent years, but “the 2004 rate of 4.9 per 100,000 remained higher than the 2000 goal of 3.5. This goal was established as part of the national strategic plan for TB elimination,” the authors noted. Also, health care workers (HCWs) in different areas of the country face different risks.
One key change that makes these guidelines different is the use of the term “tuberculin skin tests” instead of purified protein derivative. Also, the guidelines state that the QuantiFERON-TB Gold test can be used instead of tuberculin skin tests in TB screening programs for health care workers. This one-step blood assay for M. tuberculosis (BAMT) is approved by the Food and Dug Administration.
Other changes include the following:
▸ Expansion of settings. The guidelines have site-specific recommendations for more inpatient and outpatient setting types.
▸ More concise criteria for who needs serial testing for TB infection. Recommendations vary depending on the type of health care setting. In some settings, the frequency of TB screening for HCWs has been decreased.
▸ New airborne terms. The term “airborne isolation” replaces “respiratory isolation” while the term “airborne infection isolation room” (AII room) is defined as “a special negative-pressure room for the specific purpose of isolating persons who might have suspected or confirmed infectious TB disease from other parts of the [health care] setting.”
▸ Instructions on proper respirator use. This includes criteria for selecting respirators and recommendations for annual training and fit testing.
▸ A nine-page “frequently asked questions” section. One of the questions posed is: “Do health care settings or areas in the United States exist for which baseline two-step skin TST for newly hired HCWs is not needed?”
The reply reads: “Ideally, all newly hired HCWs who might share air space with patients should receive baseline two-step TST (or one-step BAMT) before starting duties. In certain settings, a choice might be offered not to perform baseline TST on HCWs who will never be in contact with or share air space with patients who have TB disease, or will never be in contact with clinical specimens (e.g., telephone operators in a separate building from patients).”