Guidance

Tuberculosis (TB) guidance for adult social care settings

Published 28 October 2026

This content is owned and managed by UKHSA.

This section provides information about tuberculosis (TB), including how it spreads, the signs and symptoms to look out for, and the steps that can be taken to prevent its spread in adult social care settings. It also explains how to support people affected by TB and where staff can access advice and support if they are affected themselves.

Key summary

• TB is an infection (usually in the lungs) that can be treated with antibiotics
• it spreads through the air but usually needs close, prolonged contact for transmission
• symptoms include a cough lasting more than 3 weeks, fever or night sweats, weight loss, and tiredness
• early recognition and medical assessment are important
• care should be respectful, confidential, and reduce stigma
• latent TB cannot be passed to others

Call for action

• spot symptoms early and seek advice quickly
• report concerns and follow local processes
• reduce spread: by keeping people physically separated, use masks if advised, and improve ventilation
• follow advice from TB specialists and IPC teams
• support people with dignity and clear information
• staff with infectious active TB must stay off work until advised returning by their specialist TB team Work with public health teams on contact tracing

This guidance is for care and support workers and managers working in adult social care (ASC) settings. It gives information on tuberculosis (TB), how to support people accessing care and support, the principles for preventing the spread of TB in ASC settings, and advice for care and support workers affected by TB.

Reducing stigma is an important part of helping individuals manage their illness. Information must be shared with dignity, care and respect for privacy. Being diagnosed with TB does not define an individual. Personal and medical information should be kept confidential and only shared with people who need it to provide care or carry out public health duties.

The term ‘People or person’ is used throughout this guidance to refer to people accessing care and support in ASC settings such as care homes for older adults, homes for younger adults with learning disabilities, day centres, extra care services, supported living and care provided at home (domiciliary care).

Care and support staff working with people should follow the infection prevention and control (IPC) principles set out below to minimise the risk of spreading TB within any ASC setting.

Safeguarding statement

In keeping with the Mental Capacity Act 2005, care and support workers must presume capacity unless assessed otherwise, provide tailored support to enable understanding, and document any capacity assessments clearly. Where a person lacks capacity, decisions or protective measures must be made in their best interests and be proportionate, necessary, and least restrictive, with involvement from relevant professionals and those close to the person wherever appropriate.

Always ensure any information sharing about a person who is infectious is done so in a compassionate but proportionate way.

What tuberculosis is

Tuberculosis (TB) is an infectious disease caused by bacteria. It is most common in the lungs (pulmonary TB), but it can affect any part of the body, for example, brain, spine and lymph nodes (extra-pulmonary TB).

When a person has symptoms of TB it’s called TB disease (also referred to as active TB). However, the person is usually only infectious when TB is diagnosed in the lungs (and sometimes the larynx, also known as the voice box, just above the windpipe).

Sometimes a person may have had a blood test that indicates they have TB in their body, but they have no symptoms. This is called latent TB infection; the person is not infectious; PPE use is not required as they cannot spread TB to another person.

Symptoms of TB

A person with TB disease (active TB) may have the following symptoms:

• a persistent cough that does not get better after 3 weeks
• coughing up mucus (phlegm) with blood in it
• a fever or night sweats
• no appetite
• unexplained weight loss
• extreme tiredness

Being aware of signs and symptoms of TB and seeking early clinical advice from a registered healthcare professional helps with early TB diagnosis and treatment.

How TB is spread

TB spreads through the air when a person with TB disease (active TB) in their lungs or larynx coughs, sneezes, or speaks, releasing bacteria into the air that others can breathe in. However, TB is not easily spread from person to person unlike other respiratory infections such as flu or COVID-19. Although close indoor exposure and poor ventilation may increase the risk of transmission of TB, it usually requires close and regular prolonged contact with a person diagnosed with infectious TB to get infected with it. TB cannot be transmitted through touch, or by using the same utensils or crockery.

People at increased risk of TB

Some people are more likely to get very ill from TB if they are exposed to it. This can be because of where they live, their health, or how their body fights infections. People who are more likely to get very ill from TB include:

• older adults
• children, especially under 5 years of age
• those who smoke, use drugs or consume alcohol
• those with a history of imprisonment or homelessness (more likely to have been exposed to TB due to shared spaces, overcrowding, or unstable living conditions)
• those who have weakened immune systems, for example due to diabetes or medications such as high dose steroid treatments, or chemotherapy

TB treatment

TB disease (active TB) is a serious condition, but it can be treated with antibiotics. The treatment is free. The standard treatment length is 6 months, however, there are cases in which the treatment will be longer, for example, for people with TB meningitis and drug-resistant TB. 

TB specialists provide TB treatment and care. They will give information, advice, and support to people on the medicines and management of TB for the duration of treatment.

What to do if a person is suspected to have infectious TB

If TB is suspected:

• identify symptoms
• seek urgent clinical advice
• notify the manager
• follow local escalation routes
• protect confidentiality and avoid stigma
• support the person compassionately
• use appropriate PPE, including a fit-tested and fit-checked FFP3 respirator when caring for individuals with infectious pulmonary or laryngeal TB
• seek public health or TB specialist advice where needed (this should be done via the TB specialist in the first instance)
• document actions needed as per local processes

If you are looking after a person who is suspected to have infectious pulmonary or laryngeal TB, follow the guidance below:

Recognise and escalate

It is important to seek clinical advice early if there is concern that a person may have infectious TB, whether they are a person accessing care or a care and support worker.

A best interest decision may be needed in accordance with the Mental Capacity Act  where a person lacks capacity.

Report the concern to a registered healthcare professional (for example, GP) in line with local processes so that a clinical review can be arranged by a TB specialist. In domiciliary care and smaller ASC settings, alert the registered manager to ensure clinical advice is sought from a registered healthcare professional.

Reduce exposure to others

If TB is suspected by the registered healthcare professional, ask the person to wear a fluid resistant surgical mask (FRSM) when they have contact with people visiting them or if they need to leave their accommodation until they have been assessed by a TB specialist and given appropriate advice.

If a person has cognitive impairments or other factors that may impact their ability to adhere to staying away from others or wearing a mask, complete a risk assessment with their TB specialist in the first instance.

Support the person to stay away from others and remain in their own room or at home, if possible, and to avoid accessing communal areas and non-essential visitors until they are advised by their TB specialist that they are not infectious. The NHS TB specialist will confirm when this is no longer required. Continue to support the person with all their care needs whilst they are potentially infectious.

If infectious TB (active TB) is suspected or confirmed, the individual should stay in their own room until a TB nurse or TB team confirms they are no longer infectious. They should only leave for essential appointments or to spend time outside away from others.

When providing care, make sure the room is well ventilated by opening windows where it is safe, appropriate and comfortable to do so. Spending time outdoors is safe and should usually be encouraged, as it supports health and wellbeing and can help make visiting safer.

Support the person to understand the importance of good respiratory and cough hygiene

Care and support workers should follow any specific IPC precautions recommended by the UKHSA local HPT, IPC or TB specialist.

What to do if a person is confirmed to have infectious TB

If you are looking after a person with confirmed infectious TB, in addition to the above actions:

Contact the local TB specialist Service in the first instance for further information and advice. The TB service may contact the UKHSA local HPT for expert advice, to address any queries, to undertake further risk assessment, to convene an Incident Management Team (IMT) if required, and/or to liaise directly with the setting as appropriate.

The person’s care manager should liaise with the local NHS TB specialist who will confirm the person’s infectivity status and provide advice on informing care partners.

With advice from the specialist TB team support the person with their TB treatment and management of side effects.

What to do if ASC care and support workers are diagnosed with infectious TB

If ASC care and support workers are diagnosed with infectious TB by a registered healthcare professional, they should remain off work until their treating NHS TB specialist advises they are no longer infectious. If a care and support worker or other staff member working in ASC settings is diagnosed with TB, they must continue to be treated and supported in line with workplace sickness management policies and must be treated equally. Information sharing must be handled with dignity, confidentiality and care. Personal and medical information should be kept confidential and only shared with people who need it to provide care or carry out public health duties.

The care and support worker may be required to provide information about their employer, the hours they work, and the environment they work in to their TB clinical team to assist further public health actions. This information will be shared with the local UKHSA HPT. They will assess the risk and decide who has been in close contact for a long time, who needs testing, what information needs to be shared, and what should happen next.

People and care and support workers who are known to have been in close contact with a case of infectious TB (either in the ASC setting or the community) will be informed and managed by the local UKHSA HPT and the local NHS TB specialists. The UKHSA local HPT or TB specialist will manage the contact tracing process, including a risk assessment with the care setting manager or nominated deputy.   

ASC staff are not expected to make contact tracing decisions. They may be asked to provide information to the UKHSA local HPT or TB team to support contact tracing.

All people identified as a contact will be managed jointly by the local TB service and the UKHSA local HPT, with roles and responsibilities agreed based on the risk assessment. Care and support workers may get a letter telling them they have been near someone with TB and what they need to do. They might be asked to have a TB test and go to more appointments, or they may be told to watch for signs of TB and seek help if they feel unwell.

In the rare case of an outbreak of TB, the Communicable disease outbreak management guidance  will be used.