TABLE 50.9.

Precautionary Procedures for Patients with Infectious Tuberculosis

Follow Precautionary Procedures for Infectious TB Patients Who Also Require Emergency Surgery. Category IB, IC

1.Use an N95 respirator approved by the National Institute for Occupational Safety and Health without exhalation valves in the operating room. Category IC 2.Intubate the patient in either the AII room or the operating room; if intubating the patient in the operating room, do not allow the doors to open until 99% of the airborne contaminants are removed. Category IB 3.When anesthetizing a patient with confirmed or suspected TB, place a bacterial filter between the anesthesia circuit and the patient's airway to prevent contamination of anesthesia equipment or discharge of tubercle bacilli into the ambient air. Category IB 4.Extubate and allow the patient to recover in an AII room. Category IB 5.If the patient has to be extubated in the operating room, allow adequate time for ACH to clean 99% of airborne particles from the air, because extubation is a cough-producing procedure. Category IB

Use Portable, Industrial-Grade HEPA Filters Temporarily for Supplemental Air Cleaning During Intubation and Extubation for TB Patients Who Require Surgery. Category II

1.Position the units appropriately so that all room air passes through the filter; obtain engineering consultation to determine the appropriate placements. Category II 2.Switch the portable unit off during the surgical procedure. Category II 3.Provide fresh air as per ventilation standards for operating rooms; portable units do not meet the requirements for the number of fresh ACH. Category II

If possible, schedule TB patients as the last surgical cases of the day to maximize the time available for removal of airborne contamination. Category II

No recommendation is offered for performing orthopedic implant operations in rooms supplied with laminar airflow. Unresolved issue

Maintain backup ventilation equipment (e.g., portable units for fans or filters) for emergency ventilation of operating rooms, and take immediate steps to restore the fixed ventilation system. Category IB, IC (AIA: 5.1)

ACH, air changes per hour; AII, airborne infection isolation; HEPA, high-efficiency particulate air.

Centers for Disease Control and Prevention. Guidelines for environmental infection control in health-care facilities: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). 2003. http://apps.who.int/iris/bitstream/10665/44102/1/9789241597906_eng.pdf