Respiratory isolation in a teaching hospital with low-to-moderate rate of tuberculosis: Compliance with Centers for Disease Control and Prevention guidelines for identifying patients who may have active tuberculosis

Background: Because of the limitation of isolation spaces suitable for tuberculosis, proper use of these spaces is prudent. We examined the current approach to respiratory isolation to determine the compliance with Centers for Disease Control and Prevention (CDC) guidelines for identifying active tuberculosis. Methods: A retrospective review was performed of all patients placed in respiratory isolation and those with pulmonary tuberculosis. Results: Seventy-seven instances of isolation and three admissions without isolation were encountered. Isolated patients met CDC guidelines for infectiousness in 59 of 77 instances (76.6%). The remaining patients were isolated with findings not characteristic of active tuberculosis (10 instances), normal chest radiograph (6 occasions), or without chest radiograph (2 instances). The time of implementing isolation was the first hospital day in 58 instances (75.3%) and 2 to 14 days in 19 instances (24.7%). Isolated human immunodeficiency virus-infected patients were more likely to meet CDC guidelines for infectiousness (21/22 [95.5%] vs 38/55 [69.1%] instances) and to be isolated on a timely basis (18/22 [81.8%] vs 40/55 [72.7%]). Tuberculosis was documented in 15 instances and isolation was delayed or never implemented in 5 and 3 instances, respectively. Conclusions: Compliance with CDC guidelines for respiratory isolation in patients not infected with human immunodeficiency virus is suboptimal. Many isolated patients do not meet these guidelines, and isolation is delayed or not implemented in patients who may have tuberculosis.