In existing healthcare facilities that have natural ventilation, when possible, effective ventilation should be achieved by
proper operation and maintenance on a regular schedule. Simple natural ventilation may be optimized by maximizing the
size of the opening of windows and locating them on opposing walls.

Adequate ventilation in healthcare facilities is essential for preventing transmission of airborne infections, and is strongly
recommended for controlling spread of TB. The choice of ventilation system will be based on assessment of the facility and
informed by local programmatic, climatic and socioeconomic conditions (refer to guideline for Controls 10a and 10b). Any ventilation system
must be monitored and maintained on a regular schedule. Adequate resources (budget and staffing) for maintenance are
critical.

Hospital stay is generally not recommended for the evaluation of people suspected of having TB or for the management of
patients with drug-susceptible TB, except in cases that are complicated or have concomitant medical conditions that require
hospitalization. If hospitalized, patients with TB symptoms should not be placed in the same area as susceptible patients
or infectious TB patients (see rest of the recommendation p. 12 of the guideline).

To minimize the spread of droplet nuclei, any coughing patient with a respiratory infection – in particular, patients with or
suspected of having TB – should be educated in cough etiquette and respiratory hygiene; that is, in the need to cover their
nose and mouth when sneezing and/or coughing (see rest of the recommendation p. 12 of the guideline).

It is also crucial to separate infectious patients after triage. The specific criteria (e.g. smear and culture status) for separating
patients will depend on the local settings and patient population. In particular, patients living with HIV or with strong clinical

Health workers may gain additional protection from TB through the use of particulate respirators that meet or exceed the
N95 standards set by the United States Centers for Disease Control and Prevention/National Institute for Occupational
Safety and Health (CDC/NIOSH) or the FFP2 standards that are CE certified (see rest of recommendation p. 15 of guideline).

Prompt identification of people with TB symptoms (i.e. triage) is crucial. The specific criteria for triaging patients will depend
on the local settings and patient population. However, in general, people suspected of having TB must be separated from
other patients, placed in adequately ventilated areas, educated on cough etiquette and respiratory hygiene, and be diagnosed as a matter of priority (i.e. fast tracked).

In adults and children with signs and symptoms of extrapulmonary TB, Xpert MTB/RIF or Xpert Ultra should be used for rifampicin-resistance detection rather than culture and phenotypic DST.

In adults and children with signs and symptoms of extrapulmonary TB, Xpert Ultra may be used in lymph node aspirate and lymph node biopsy as the initial diagnostic test for lymph nodes TB rather than smear microscopy/culture.

In adults and children with signs and symptoms of extrapulmonary TB, Xpert MTB/RIF may be used in lymph node aspirate, lymph node biopsy, pleural fluid, peritoneal fluid, pericardial fluid, synovial fluid or urine specimens as the initial diagnostic test for respective form of extrapulmonary TB rather than smear microscopy/culture.