Guidelines for Home and Hospital Isolation of Infectious Tuberculosis Patients***

TB Patient Characteristics at Diagnosis

Sputum Acid Fast Bacilli (AFB) smear
positive, and/or NAA positive or patient
suspected of having active TB.

Current Isolation and Release Criteria

Hospitalized under inpatient airborne
isolation or home isolation and being
released to:
General hospitalization, or
Outpatient congregate setting, or
Home or setting with high-risk contacts

Guidelines for Adults and Children with Adult Type Disease

Discharge from airborne isolation patient must meet all the following criteria:

1 Have received standard multidrug anti-TB therapy for at least 2
weeks if original AFB smear positive OR on therapy for 5-7 days if
original AFB smear was negative

2 Demonstrated adherence to treatment (DOT)

3 Demonstrated clinical improvement

4 Have 3 consecutive negative AFB smears collected at least 8 hours
apart with at least 1 early morning specimen

5 Have no risk factors for drug resistance

TB Patient Characteristics at Diagnosis

Sputum AFB smear negative and TB is
not suspected, NAA testing if done is
negative and/or another diagnosis is
likely

Current Isolation and Release Criteria.

Hospitalized under inpatient airborne isolation and being released to:
General hospitalization Return to school, or Return to work, or Allowed to travel on public transportation

Guidelines for Adults and Children with Adult Type Disease

Discharge from airborne isolation patient must meet all the following criteria:
1) Have 3 consecutive negative AFB smears collected at least 8 hours apart with at least 1 early morning specimen
2) TB is not likely and another diagnosis is identified

TB Patient Characteristics at Diagnosis

Sputum AFB smear negative and TB is
suspected or confirmed through NAA
testing

Current Isolation and Release Criteria

Hospitalized under inpatient airborne
isolation or home isolation and being
released to return to normal activities
including:
General hospitalization
Return to school, or
Return to work, or
Allowed to travel on public transportation

Guidelines for Adults and Children with Adult Type Disease

Discharge from home isolation patient must meet all the following criteria:
1) Have received standard multidrug anti-TB therapy for at least 5-7
days
2) Demonstrated adherence to treatment (DOT)
3) Demonstrated clinical improvement
4) Have 3 consecutive negative AFB smears collected at least 8 hours
apart with at least 1 early morning specimen
5) Have no risk factors for drug resistance

 

TB Patient Characteristics at Diagnosis

TB MDR/ or XDR confirmed infection

Current Isolation and Release Criteria

Hospitalized under inpatient airborne
isolation or home isolation and being
released to return to normal activities
including:
Return to school, or
Return to work, or
Allowed to travel on public
transportation

Guidelines for Adults and Children with Adult Type Disease

Discharge from home isolation patient must meet all the following criteria:
1) Receiving and tolerating appropriate multidrug anti-TB regimen
2) Demonstrated adherence to treatment (DOT)
3) Demonstrated clinical improvement
4) Have 3 consecutive negative AFB cultures*
*Expert opinion varies; some experts satisfied with negative smears

A TB suspect or case may be released from hospital to home setting if there are no high risk individuals in the home even if they do not meet the criteria for
release from isolation. Clinical judgment and consultation with public health is needed.

Revised November 2011

Guidelines for Home and Hospital Isolation of Infectious Tuberculosis Patients

Frequently Asked Questions
My patient is on home isolation. He has
asked if he can go out as long as he wears
a mask. What should I say?
Patients should stay home unless they
have a medical appointment then they
should wear a mask. Patients may
engage in outdoor activities such as
walking.

What if the patient cannot produce sputum
how do we tell if the patient has
converted to smear or culture negative?
Every effort should be made to obtain
sputum including induced sputum through
respiratory therapy. However, a few
patients cease to produce sputum before
conversion to smear or culture negative
can be confirmed. For these patients, you
will need to use clinical judgment such as
symptom resolution and CXR
improvement.

What if the patient is non adherent with
home isolation but is adherent with DOT?
Most states have legislation to obtain a
legal order that covers both isolation and
adherence to treatment. If the patient is
documented non adherent with home
isolation, check the legal authority you
have in your jurisdiction to enforce
isolation.

What if the patient remains smear positive
but cultures come back negative?
As long as cultures are negative the
specimens contain nonviable organisms.
The mycobacteria are dead and not
capable of spreading disease. The patient
may be released from isolation.

Factors that Predict Likely Transmission of TB

Release from isolation may involve judgment calls on the part
of the public health authority. These are the factors to take
into account when considering whether or not a patient is noninfectious:

Anatomical site
Pulmonary, laryngeal or pleural TB disease - infectious;
laryngeal tends to be the most infectious

Sputum bacteriology
Positive culture and AFB smear indicates more efficient
transmission than if positive culture and negative smear

Radiographic findings
Cavities on chest radiographs and extensive infiltrates are
associated with more transmission than noncavitary chest
radiographs and limited disease

Behaviors that increase transmission
Frequent coughing Singing
Poor cough etiquette Behavior such as shouting
High sociability of the index patient

Age
Children aged < 10 years old are unlikely to transmit TB unless
the CXR is similar to adult type disease (especially cavitary)

HIV status
HIV positive patients are as infectious as non-HIV positive
patients

Administration of effective treatment/Adherence to treatment
and DOT
The exact rate of decrease in viable mycobacterial organisms
cannot be predicted. Some patients with severe disease will
remain smear and culture positive after several weeks of
treatment. Treatment with both isoniazid and rifampin is
associated with a more rapid conversion of smears and
cultures to negative.

References
Guidelines for the Investigation of Contacts
of Persons with Infectious Tuberculosis:
Recommendations from the National
Tuberculosis Controllers Association and
CDC. Centers for Disease Control and
Prevention. MMWR: December 16, 2005;
Volume 54 (RR-15); p1-37.

Guidelines for Preventing the Transmission
of Mycobacterium tuberculosis in Health-
Care Settings. Centers for Disease Control
and Prevention. MMWR: December 30,
2005; Volume 54 (RR17).

Heartland National TB Center
2303 SE Military Drive
San Antonio, Texas 78223
1-800-TEX-LUNG
1-800-839-5864
www.HeartlandNTBC.org

*Cavitary infiltrate
**Clinical assessment and judgment should always be applied with each individual patient**
***Individuals who are returning to work or live in environments with immunocompromised individuals (neonates, HIV+, transplant recipients, etc.) should be considered individually; more conservative measures should be considered.