IPC 3.7 Tuberculosis

1.0 Introduction
2.0 Definitions
2.1 Mode of transmission
2.2 Signs and symptoms - clinical indications
2.3 Screening
3.0 Antimicrobial treatment guidance
4.0 Infection prevention and control principles
4.1 Isolation
4.2 Hand hygiene
4.3 Respiratory / Cough hygiene
4.4 Personal protective equipment
4.5 Equipment
4.6 Environmental cleaning
4.7 Linen
4.8 Body fluids
4.9 Waste
4.10 Occupational exposure
5.0 Outbreaks
6.0 References/Source documents
Appendix 1

1.0 Introduction

Organism

Tuberculosis or TB Tuberculosis (TB) is a curable infectious disease caused by a type of bacterium called Mycobacterium tuberculosis ('M. tuberculosis' or 'M.Tb'), or other bacterium in the M. tuberculosis complex (that is, M. bovis or M. africanum). It is spread by droplets containing the bacteria being coughed out by someone with infectious TB, and then being inhaled by other people.

The initial infection clears in over 80% of people but, in a few cases, a defensive barrier is built round the infection and the TB bacteria lie dormant. This is called latent TB; the person is not ill and is not infectious. If the immune system fails to build the defensive barrier, or the barrier fails later, latent TB can spread in the lung (pulmonary TB) or develop in the other parts of the body it has spread to (extrapulmonary TB). Only a small proportion of people with latent TB will develop symptoms ('active TB').

Incubation period

Three to nine weeks

Period of communicability

Patients are deemed infectious (with pulmonary and laryngeal TB ) Usually up to two weeks after commencement of compliant antibiotic treatment unless the patient has risk factors for drug resistance. TB in other sites may not be infectious.

Individuals at risk

Close contacts of an infected person (this is defined as anyone who is having regular contact and can include household contacts and work colleagues) Born or lived in a high incidence area for TB.

Weakened immune systems, eg HIV patients, cancer patients Under 5 years of age.

Live in overcrowded conditions or homeless Smokers, excessive alcohol use and drug users History of untreated TB both Latent and active TB.

Notifiable disease

Yes- To UKHSA within 5 days of diagnosis or clinical suspicion.

Informing IPC team

Yes- and to relevant TB Team.

Nottinghamshire (Queens Medical Centre or Nottingham Hospital) RDASH (Rotherham and South Humber NHS Trust) for Bassetlaw and Rotherham.

Lincolnshire Community Health Care Trust for Lincolnshire University Hospital Trust Leicester for Leicestershire.

Sherwood Forest Hospitals Trust, Mansfield (SFHT).

2.0 Definitions

Active TB is when a patient is displaying symptoms. TB can be smear negative (closed) or smear positive (open). Smear positive are classed as infectious.

Latent TB is dormant TB and the person is asymptomatic and non infectious (normally found on mass or contact screening).

Multi Drug Resistant TB (MDR TB) is caused by bacteria that are resistant to the antibiotics usually used to treat TB (Rifampicin and Isoniazid). This may occur if a patient is not compliant with initial TB Treatments or originates from a country with high MDR-TB rates.

2.1 Mode of transmission

Transmission is via inhalation of infectious droplets produced by people with active respiratory/laryngeal TB. Latent TB (asymptomatic) cannot be spread to others. Contacts will be decided by the TB Team and tested as appropriate. Contact is usually household contacts or prolonged work contacts.

2.2 Signs and symptoms - clinical indications

A persistent cough that lasts more than three weeks, possibly coughing up phlegm or mucous, may contain blood.
Feeling tired/ exhausted
A high temperature
Night sweats
Loss of appetite
Weight loss
Feeling generally unwell
Children may have difficulty gaining weight and growing
If TB has spread to other parts of the body, such as lymph nodes, brain and bones other symptoms may be displayed such as:
Swollen glands, swollen joints
Body aches/ pains
Stomach/ pelvic pain
Constipation
Dark cloudy urine
Headache, confusion, stiff neck
Rash (anywhere on the body)

2.3 Screening

For symptomatic patients:

X-Rays, chest (and other areas depending on symptoms)
Ultrasound scans, CT Scans
Sputum samples for Acid Fast Bacilli (AFB) 3 are required over 3 separate days and should be taken first thing in the morning and require at least 3mls.
Link to obtaining specimen policy
Appropriate biopsies
Contact Screening
If there has been close/ household contact with a person with TB, the contact may be asked to have a Mantoux test or a blood test for presence of TB by the appropriate TB Team. Contacts will be decided by TB Team and are usually prolonged.

3.0 Antimicrobial treatment guidance

Lower respiratory tract infections - Tuberculosis

Active TB is treated with a course of antibiotics a minimum of 6 months in total dependant on the location and sensitivity of the TB, Usually started under guidance of TB Specialist

4.0 Infection prevention and control principles

(link to NICM state any variation)

4.1 Isolation

Patient placement/assessment of infection risk (NHS England)

In hospital setting- Must be isolated immediately on clinical suspicion and isolated until TB therapy has been taken usually for 14 days , but under guidance of TB Specialist team.

If patient is at home advise to stay indoors for 2 weeks once started on treatment and limit visitors.

Offender health- if clinically suspected pulmonary TB must be single cell. Patients who are deemed infectious (active) may be admitted to hospital for treatment and remain until on treatment for 14 days and clear sputum samples.

4.2 Hand hygiene

NHS England » Chapter 1: Standard infection control precautions (SICPs)

Best Practice: How to hand wash step by step images

4.3 Respiratory / Cough hygiene

Patient to be taught cough etiquette and to dispose of tissues and wash hands after coughing/ blowing nose etc. A fluid repellent face mask must be worn by the patient -if patient has to come out of isolation for any tests etc.

Respiratory and cough hygiene (NHS England)

4.4 Personal protective equipment

Personal protective equipment (PPE)

Personal protective equipment (PPE): fluid-resistant surgical masks (FRSM) and respiratory protective equipment (RPE)

Aide memoire for optimal patient placement and respiratory protective equipment (RPE) for infectious agents in hospital inpatients (based on evidence from WHO, CDC and UKHSA)

Posters:

Donning and Doffing posters must be displayed:

Putting on and Removing Personal Protective Equipment (PPE)

4.10 Occupational exposure

All staff should be vaccinated (BCG) before working with TB patients. Prolonged exposure without the correct PPE may prompt screening. Contact Occupational Health for advice and support.

Vaccinations for Healthcare Workers (The page is available from the 'Vaccinations for Healthcare Workers' on the Connect site)

5.0 Outbreaks

UKHSA East Midlands will lead on this. They must be informed ASAP. Local IPC Team and TB teams will support actions.

6.0 References/Source documents

Tuberculosis Programme

NICE Guidance Tuberculosis (NG33) 13 January 2016 Updated 12 September 2019

Tuberculosis Information GOV.UK - pages accessed 17/08/2023

Tuberculosis Care of the patient with Pulmonary or Laryngeal TB in Hospital Doncaster and Bassetlaw Teaching Hospital, NHS Foundation Trust June 2020- June 2023

Appendix 1

TB patient information leaflet

TB Latent testing and treatment

Resource for Prison staff

IPC 3.7 Tuberculosis

Accessibility links

Search the Nottinghamshire Healthcare NHS Foundation Trust website