ATS Pulmonary Function Laboratory Manual

ATS Pulmonary Function Laboratory Management & Procedure Manual | 3rd Edition

2.4. Management of patients who may have active TB in ambulatory-care settings and emergency depart- ments (9): 1. Vigorous efforts should be made to identify promptly patients who have active TB. Health care workers, who are the first points of contact in facilities that serve populations at risk for TB, should be trained to ask questions that will facilitate identification of patients with signs and symptoms suggestive of TB. 2. TB precautions should include: a. Placing these patients in a separate area apart from other patients, not in open waiting areas. b. Giving these patients surgical masks and instructing them to wear the masks. c. Giving the patients tissues and instructing them to cover their mouths and noses with the tissues when coughing or sneezing. 2.5. Management of hospitalized patients who have confirmed or suspected TB (8): 1. Any patient suspected of having or known to have infectious TB should be placed in a TB-isola- tion room with appropriate ventilation characteristics. 2. A patient placed in isolation should remain there with the door closed. 3. Diagnostic procedures (e.g., PF tests) should be performed in the isolation room, if possible, to avoid transporting patients through other areas of the facility. 4. A patient with infectious TB, who must be transported outside the isolation room for medi- cally essential procedures, should wear a surgical mask that covers their mouth and nose during transport. 2.6. Ventilation recommendations for TB isolation and treatment rooms: 1. The American Society of Heating, Refrigerating and Air-Conditioning Engineers, Inc. (ASHRAE) recommends a minimum of six air changes per hour (ACH) for TB-isolation and treatment rooms. 2. Ventilation rates of at least 6 ACH are likely to produce an incrementally greater reduction in the concentration of bacteria in a room than are lower rates (9). 3. Air from TB-isolation rooms and treatment rooms used to treat patients who have known or suspected infectious TB should be exhausted to the outside in accordance with applicable fed- eral, state, and local regulations. 4. In cases where recirculation of air into the general ventilation system is unavoidable, high- efficiency particulate air (HEPA) filters should be installed in the exhaust duct leading from the room to the general ventilation system. 5. Upper-room air ultraviolet germicidal irradiation (UVGI) may be used as an adjunct to general ventilation in the isolation or treatment room. Ultraviolet lamps should be installed properly and maintained adequately and irradiance levels should be monitored. 2.7. Respiratory protection 1. Respiratory protection approved by the National Institute for Occupational Safety and Health (NIOSH) must be used by persons present during cough-inducing or aerosol-generating proce- dures on patients with TB.

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