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Infection control and prevention - TB

Tuberculosis (TB)

Infection control principles and practices for local public health agencies

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TB - Preventing transmission

Mycobacterium tuberculosis is transmitted in airborne particles called droplet nuclei that are expelled when persons with pulmonary or laryngeal TB cough, sneeze, shout, or sing. The tiny infectious particles can be carried by air currents throughout a room or building. Tuberculosis is not transmitted by direct contact or via contaminated surfaces or items.

Local public health agency personnel are potentially exposed to TB during case management activities such as directly observed therapy or when persons with unrecognized pulmonary TB are present in the agency facility. Local public health agencies should establish TB infection control programs that include administrative and respiratory protection measures to help prevent TB transmission among staff and visitors. Environmental engineering of air handling systems to create airborne infection isolation rooms is used to house hospital TB patients but is usually not available in public health settings.

Administrative measures include assigning a designated staff person responsibility for TB infection control, conducting a TB risk assessment for the facility, writing a control plan, and implementing effective work practices for detecting and managing clients entering the facility with signs and symptoms that may indicate active TB disease.

Respiratory protection measures that include use of N-95 respirators are also necessary for public health personnel with exposure to active TB cases. A respiratory protection program should be established to provide staff training, fit-testing, and medical evaluation for respirator use.

The following general practices should be in place in all local public health agency settings. 

Basic measures to prevent transmission of TB in local public health agencies:

  • Establish policies that minimize or eliminate the presence of suspect or known TB cases in local public health agency facilities. 
  • Establish cough etiquette practices among staff and clients. Provide tissue, hand hygiene products, and waste containers in common areas such as waiting rooms so persons with respiratory symptoms can contain coughing and sneezing. Have surgical masks available for persons to wear while waiting, and place persons with respiratory symptoms in an examination room or area away from others as soon as possible. Display posters and other educational material to encourage cough etiquette practices. Consider use of barriers such as Plexiglas “sneeze guards” for reception areas. 
  • Implement a TB screening protocol for clients presenting with cough or other respiratory symptoms. A screening tool should determine the presence of any one of the following: duration of cough for more than three weeks, blood in sputum, night sweats, unexplained weight loss, and history of TB disease or TB exposure. 
  • If screening results increase suspicion of TB, ask the client to wear a surgical mask and place in a private examination room or remove from others immediately. All staff members entering the examination room should wear a NIOSH approved fit-tested N-95 respirator. Once the room is empty, it should remain unoccupied for a period of time to clear the air of airborne TB particles (see Table 1 in the CDC Guidelines for Preventing Transmission of TB for required times). 
  • Do not perform aerosol inducing procedures or sputum collections in public health facilities, as negative pressure room are usually not available to contain airborne particles generated by these procedures. 
  • Staff doing home visits for infectious TB patients should wear NIOSH approved fit-tested N-95 filtering face pieces or powered air-purifying respirators while in the shared air space of the patient.

Additional resources


Gwen Borlaug, Infection Control Epidemiologist
Wisconsin Division of Public Health 
Bureau of Communicable Diseases
(Phone 608-267-7711)  (Fax 608-261-4976)

Last Revised: August 05, 2014