Guidance

Summary of recommendations

Updated 9 October 2025

Applies to England

Introduction

This companion document summarises the recommendations outlined in the main guidance on the management of tuberculosis (TB) in secure settings. It is designed to support the adoption and implementation of the main guidance within these settings.  

Screening at reception

In most secure sites, where radiography is unavailable, conduct a 2-stage verbal screening process:

• reception screening on day 0
• secondary screen on day 2 to 7
• recall appointment if required 3 weeks after reception or secondary screen

If available, chest X-ray (CXR) is recommended within 48 hours of arrival as these are highly sensitive for TB.

Routine testing for latent TB infection (LTBI) is not nationally commissioned, but important in high-incidence areas. It may also be considered for foreign nationals.

Management of residents with TB

All residents with confirmed TB should be urgently referred to NHS TB services, with detailed clinical information shared.  

If a resident is transferred between prisons then clinical records must be checked to ensure continuity of care for TB if required.

Approved premises do not have on-site healthcare. Residents must register with a community GP. 

Management of symptomatic residents

Main symptoms of TB include:

• cough
• coughing up blood
• weight loss
• fever
• sweats
• lymph-node swelling
• fatigue

Residents with any symptoms of TB should be immediately referred to NHS TB service. If they are unstable, they should be urgently transferred to hospital. For other residents, consider appointments using telemedicine where possible.

Respiratory isolation is required for residents with suspected pulmonary or laryngeal TB.

Diagnosis

Symptomatic residents require:

• 3 supervised sputum samples (including early morning)
• TB PCR and smear microscopy
• CXR arranged promptly

Potentially infectious cases should remain isolated until cleared after treatment and NHS TB assessment.

Treatment and monitoring

Directly observed therapy (DOT) is the default approach in secure settings. If this is affecting adherence, it can be adapted based on assessment.

The NHS TB nurse should visit within 5 days of commencing TB treatment to assess side effects and clinical issues, and track adherence.

Non-engagement with treatment requires Incident Management Team (IMT) involvement. In community settings, legal interventions under public health law are possible as a last resort.

Incident and outbreak response

An incident is defined as being where anyone with pulmonary or laryngeal TB has been in a secure setting during their infectious period.

An outbreak is an incident in which 2 linked cases of TB are linked by time, place, common exposure or TB strain.

The IMT coordinates the response to incidents or outbreaks, including contact tracing and screening.

Principles of contact tracing are:

• prioritise close contacts (cellmates, staff without PPE, activity companions, visitors)
• residents who are contacts should have a symptom screen, CXR, IGRA testing, and should be isolated if symptomatic
• staff who are contacts should have a clinical assessment and occupational health referral
• visitors or other community contacts should be referred to NHS TB services

The approach to screening should be in line with the ‘stone in the pond’ model, escalating if transmission is suspected.

Infection prevention and control (IPC)

Isolation rooms should be a single cell with hygiene facilities. The door should be kept closed.

PPE for staff should include FFP3 respirators or powered hoods. Residents should wear surgical masks if they are leaving isolation.

Environmental cleaning should be carried out using chlorine-based disinfectants.

Ventilation systems should be assessed to ensure that the air from the isolation room is not extracted into other areas.

Continuity of care

With regard to transfers and releases, using medical holds may prevent unsafe movement.

Care plans are required for residents with TB being released or transferred, which should cover medications, follow-up and NTBS updates.

Infectious residents should attend any court appearances virtually where possible.

Residents with TB who are at risk of homelessness should have accommodation identified for them in advance of release. This will involve planning with local authorities and probation.

Residents with TB in IRCs should not be transferred or deported during their infectious period. If they are to be released, safe release should be coordinated with the responsible authorities.

Staff and awareness

Staff should receive TB awareness training, ongoing education, and IPC support.

Stigma reduction and resident awareness campaigns are recommended.

LTBI testing

Prioritise ruling out active disease before carrying out LTBI testing.

IGRA preferred over Mantoux testing, as this is unaffected by BCG.

High-risk groups (foreign nationals, people with social risk factors) may be preferentially offered testing as part of enhanced target testing.

There is a stronger case for routine LTBI screening in Foreign National Prisons.

Routine LTBI testing is not recommended in IRCs – focus instead on early detection of active cases.