CONTROL AND PREVENTION OF TUBERCULOSIS IN THE UNITED-KINGDOM - CODE OF PRACTICE 1994

Background - The guidelines on control and prevention of tuberculosis in the United Kingdom have been reviewed and updated. Methods - A subc ommittee was appointed by the Joint Tuberculosis Committee (JTC). Each member of this group drafted one or more sections of the guidelines, and drafts were made available to all members of the group. In the cou rse of several meetings drafts were altered and incorporated into a fi nal text. The guidelines were approved by the full JTC and by the Stan dards of Care Committee of the British Thoracic Society. In revising t he guide-lines the authors took account of new published evidence and recent concerns about drug resistance and possible effects of HIV on t uberculosis. Conclusions - (1) Ah cases of tuberculosis must be notifi ed. (2) A few patients need hospital admission. (3) Patients with posi tive sputum smears and sensitive organisms should be considered infect ious until they have received two weeks' chemotherapy. (4) Treatment o f all tuberculosis patients should be supervised by a respiratory phys ician employing standard medication guidelines and monitoring complian ce at least monthly. (5) Health care workers at risk should be protect ed by BCG vaccination and appropriate infection control measures, and evidence of infectious tuberculosis should be sought among prospective NHS staff, school teachers, and others. (6) Prison staff should be pr otected. (7) Tuberculosis should be considered in the elderly in long stay care with persistent chest symptoms. (8) Contact tracing should b e vigorously pursued with chemoprophylaxis, BCG vaccination, or follow up where applicable. (9) Entrants to the UK from high risk countries (tuberculosis incidence more than 40/100 000 population per year) shou ld be screened. (10) BCG vaccination should be offered where appropria te but not in subjects with known or suspected HIV infection. (11) The local organisation of tuberculosis services should be strengthened an d should include adequate nursing and support staff. (12) Contracts be tween purchasers and providers should specify management of tuberculos is in line with this and other JTC guidelines.