Clinical Practice Guideline for an Infection Control/Exposure Control Program in the Oral Healthcare Setting
Transmission-based Precautions

Background

The primary risk of exposure to Mycobacterium tuberculosis (MBT) in the oral healthcare setting is contact with patients with undiagnosed or unsuspected infectious tuberculous (TB) disease. A high index of suspicion and rapid implementation of precautions are essential to prevent and interrupt the transmission of MBT.

1. Identification of patients with suspected or confirmed TB disease.
   1. When reviewing the medical histories (initial and periodic), including a review of organ systems, all patients are routinely asked about a history of
      1. Exposure to TB
      2. Latent TB infection
      3. TB disease
      4. Medical conditions that increase the risk of TB disease (e.g., HIV infection)
      5. Signs and symptoms of TB disease
         1. Chronic ill health, coughing with hemoptysis, low-grade fever, weight loss, and night sweats.
2. Isolation of patients with suspected or confirmed TB disease from other patients and OHCPs
   1. Patients are not kept in the office setting any longer than required
      1. While in the office, these patients are promptly isolated from other patients and OHCPs
      2. They are instructed to observe strict respiratory hygiene and cough etiquette procedures
3. Referral of patients with suspected or confirmed TB disease for medical evaluation and /or required urgent dental care
   1. Routine dental care is postponed until a physician confirms that the patient does not have infectious TB or until it is confirmed that the patient is no longer infectious.
   2. Patients requiring urgent dental care are referred to an oral healthcare facility that meets the requirements for appropriate environmental and respiratory-protection controls.
      1. Environmental control
         1. Airborne infection isolation (AII) room
      2. Respiratory-protection control
         1. Disposable, non-powered, air-purifying, particulate-filter respirators
            1. National Institute for Occupational Safety and Health (NIOSH)-certified particulate-filter respirators (N95, N99, or N100) are used, which have the ability to filter Lessthan.3 µm particles with a filtering efficiency of 95, 99, and 99.7%, respectively.