Administration of aerosolized pentamidine (AP)
	Investigate the use of alternative therapies for PCP prophylaxis in immunocompromised patients given the increased efficacy of oral regimens (TMP/SMX--desensitization if needed or dapsone) and the decreased risk of transmission of TB by obviating the use of a cough generating procedure.
	Screen all patients for active tuberculosis before AP therapy is initiated. Screening should include medical history (with special attention to risk of prior TB exposure), tuberculin skin testing, and a baseline chest radiograph. The Nathan Smith Clinic routinely obtains sputum AFB smears on all patients referred for AP.
	Each patient should be evaluated for symptoms suggestive of TB, such as cough, fever, and night sweats, before each subsequent AP treatment. If such symptoms are elicited, a diagnostic evaluation should be undertaken before the administration of AP.
	If active TB is found, the patient should be placed on appropriate antituberculous chemotherapy. In such cases, resumption of AP treatments should proceed if possible only after the patient has been on appropriate therapy and of the proper duration to render the patient non-infectious.
	AP treatments for all patients should be administered in an individual room or booth with appropriately high air flow parameters and negative pressure to the adjacent rooms and hallways. Air should be exhausted directly outside away from windows, intake vents, and human contact or through a properly maintained and monitored HEPA filtration system. Adequate time should be allowed between patients for removal of residual pentamidine and any infectious organisms from the air when treatment rooms or booths are to be reused.
	Personnel administering AP should wear a N-95/HEPA respirator whenever they must be in the room or booth during administration of AP to patients who have or are at high risk of having tuberculosis.
	Individuals who have received AP therapy should not return to common waiting areas until any coughing has subsided.

Bronchoscopy
	Bronchoscopy should be performed rooms that meet the ventilatory requirements for Airborne Precautions (i.e. negative pressure ventilation, appropriate air exchanges per hour, and exhaustion of air directly to the outside away from windows, air intake vents, human contact or through a monitored HEPA filtration ?).
	Persons who are in the room during a bronchoscopy must wear N-95/HEPA respirator for respiratory protection.

Endotracheal Intubation and Suctioning
	Rooms occupied by intubated patients with suspected or confirmed active tuberculosis must meet the requirements of Airborne Precautions:  negative pressure ventilation (appropriate air exchange per hour) and the exhaustion of air to the outside away from windows, intake vents, and human contact.
	As required with Airborne Precautions, personnel performing endotracheal intubation/suctioning on patients with suspected or confirmed TB should wear a N-95/HEPA respirator for respiratory protection. Whenever feasible, a closed system endotracheal suction catheter should be utilized.
	Placing a bacterial filter on an endotracheal tube or on the expiratory side of the ventilation circuit in a patient with suspected or confirmed tuberculosis may help reduce the risk of contaminating ventilation equipment or the discharging of tubercule bacilli into the ambient air.

Other Procedures
	Other aerosol treatments, cough inducing procedures or aerosol generating procedures should be administered in rooms with appropriate ventilation to prevent the transmission of TB.
	Persons who must be in the room with the patient at the time of such treatments/procedures should wear a N-95/HEPA respirator for respiratory protection.