PE-141 : Guidelines for healthcare-associated tuberculosis management

Introduction: The guidelines for healthcare-associated tuberculosis management were developed in consideration of the different clinical characteristics of tuberculosis and other epidemiological characteristics of Korea and the need for more specific guidelines for the management of tuberculosis in medical institutions. Main theme: Tuberculosis control organization; 1. The director of a medical institution that treats patients with tuberculosis is recommended to appoint a tuberculosis management physician to command the tuberculosis control in the medical institution. 2. It is recommended that medical institutions that treat patients with tuberculosis establish ‘tuberculosis control guidelines’ and perform the management of tuberculosis infection in medical institutions according to the guidelines. 3. If tuberculosis patients or suspected tuberculosis patients are required to be hospitalized, they should be isolated in a single room with negative pressure ventilation and a separate pressure room or separate toilet and washroom. Personal respiratory protective equipment and contact investigation; 4. HCWs(Health care workers) or patients with suspected tuberculosis or confirmed tuberculosis should wear an N95 mask. 5. Contact surveys should be conducted with close contacts and include HCWs and patients. If probable source of infection is the increased risk of tuberculosis, contact investigation should be conducted even in daily contact or individually for everyday contact. Contact Investigation Method; 6. HCWs(Health care workers) should be examined for suspected tuberculosis symptoms and to take chest X-rays. If pulmonary tuberculosis is suspected by chest X-ray, sputum AFB smear / culture and tuberculosis nucleic acid amplification test should be performed. 7. The tuberculin skin test or interferon gamma releasing assay are useful for latent TB. Strategy for Contact Investigation Results: 8. If latent tuberculosis is diagnosed, the treatment of latent tuberculosis should be started, HCWs would not be excluded from the workplace. 9.Latent tuberculosis treatment should be performed in accordance with the recommendation for latent tuberculosis screening and management in the 2017 Tuberculosis Guidelines. 10. If patient is suspected multidrug-resistant tuberculosis, latent tuberculosis treatment is generally not recommended. Conclusion: The guidelines for healthcare- associated tuberculosis management include the tuberculosis control system of medical institutions, isolation of tuberculosis patients, respiratory protective equipment, contact investigation and treatment in cases of confirmed or suspected tuberculosis healthcare workers and patients. However, it is not complete now, and upgraded recommendations would be advisable.