OSHA Blood Borne Pathogen

and Tuberculosis Training PART II Tuberculosis

Author: Maxine Edwards, RN, ICP ECU Infection ControlPresented by: Patti Goetz, RN ECU Infection Control

Tuberculosis Airborne Pathogen

Old Enemy

New Battle

World Epidemiology 2007

1/3 of the world’s population is infected 9 million people become sick with TB

each year 2-3 million TB related deaths per year Leading cause of death due to

infectious disease in people diagnosed with HIV

13,299 cases reported in USA

MTB in the World

Six countries in Asia account for more than 50% of TB epidemic India China Bangladesh Pakistan Indonesia the Philippines

TB Trends by Case Rate

Per 100,000 Population

TB in NC and Pitt Co 2007

2007=335 cases reported in NC, ranking NC 22nd in the nation

2004= 7 cases 2006= 6 cases

2007 = 11 cases reported in Pitt Co.

MTB Cases in NC

YearYear NCNC Pitt Co.Pitt Co. ECUECU

20052005 329329 55 44

20062006 374374 55 88

20072007 345345 1111 1111

TB Cases by NC County 2007

Number 18-54 8-17 3-7 0-2

High Risk for TB in NC 2007

HIV: 9% (2006= 5%)

Homeless: 4% (2006=5%)

Alcohol abuse: 12% (2006=17%)

Foreigners: 41% (2006=36%)

Health care workers: 1% (2006=2%)

Close living conditions (prisons, nursing homes) : 5% (2006=6%)

Airborne Spreads when someone with active TB

disease coughs, talks, laughs, sneezes, or spits TB bacteria into the air

Uninfected person breathes in TB bacteria

Transmission

Fever, chills Night sweats Fatigue and weakness Cough > 2 weeks Thick, cloudy or bloody sputum Decreased appetite and weight loss Shortness of breath and chest pain

Signs & Symptoms

LATENTLATENT TB TB INFECTIONINFECTION

ACTIVEACTIVE TB TB DISEASEDISEASE

Exposed to active TB Exposed to active TB disease, bacteria disease, bacteria enters body but is enters body but is controlledcontrolled

Infection has Infection has progressed to active progressed to active disease, bacteria are disease, bacteria are multiplyingmultiplying

Positive TB skin testPositive TB skin test Positive TB skin testPositive TB skin test

No symptomsNo symptoms Will have symptomsWill have symptoms

Negative CXRNegative CXR Positive CXRPositive CXR

WILL NOT WILL NOT

INFECT OTHERSINFECT OTHERS

WILL WILL

INFECT OTHERSINFECT OTHERS

• A TB skin test or PPD will show if you have any TB bacteria in your body.

• All employees or students that are potentially exposed to TB need to receive a skin test annually.

How do we test for TB?

Two-Step Testing

Used for initial skin testing of adults who have not had a documented PPD in the last 12 months

• If first test positive, consider the person infected

• If first test negative, give second test 1-3 weeks later

• If second test positive, consider person infected

• If second test negative, consider person uninfected

Boosting

• Some people with LTBI may have negative skin test reaction when tested years after infection

• Initial skin test may stimulate (boost) ability to react to tuberculin

• Positive reactions to subsequent tests may be misinterpreted as a new infection

If patients have symptoms of TB, offer tissues and surgical masks.

Escort patients to the nearest “negative pressure” room to isolate them.

Patient should wear mask outside room and during transport to other departments

All health care workers who work with potential TB patients should wear appropriate PPE when working with infectious individuals.

How do Healthcare Workers avoid exposure to

TB?

Personal Protective Equipment (PPE)

OSHA requires the use of approved, certified respirators for respiratory protection

N-95 particulate respirator or Power Air-purifying particulate respirator (PAPRA) have been certified by NIOSH for TB protection

All staff having close contact with TB patients must be fit tested for and wear approved respirator devices

Remember your size Fit testing will be done annually for

those performing high risk procedures Others will be done every 5 yrs unless there are facial changes. You will be asked about changes at your annual health update

N-95 Respirator

Notify Prospective Health of facial changes:

large amount of weight gain or loss facial trauma and/or surgery growth or shaving of beard

If unable to wear mask, you will be instructed in the use of a PAPR

N-95 Respirator

Power Air-Purifying Particulate Respirators

(PAPR)

What do I do if I am exposed to TB ?

You will be notified by Infection Control of your confirmed exposure

After notification, call Employee Health to schedule a PPD skin test

A PPD is done at the time of exposure and repeated in 3 months

TB Exposure (cont.)

If PPD converts to positive after exposure you are assessed for active disease symptoms and will be asked to get a CXR

Referred to private physician or health dept for preventive antibiotics (latent TB) or treatment with multiple antibiotics (active TB)

What if I have Latent TB Infection?

90% of healthy people with TB infection will never develop TB disease.

Should be evaluated for prophylactic medications by the health department or a private physician.

Prophylaxis meds reduce lifetime risk of developing active TB disease by 95%

Be aware of signs and symptoms of active TB disease

You will receive antibiotics which will eventually kill the TB bacteria

in your bodyYou may return to work when no

longer infectious (usually 2-3 weeks after starting antibiotics)

What if I am diagnosed with TB disease?

Treat and Prevent TB

Must take antibiotics as directed for active TB disease

Treatment directly observed by county Health Dept.

It’s the Law!

When can I return to work if I develop active TB disease?

Once evaluated by Prospective Health

When you are no longer infectious -appropriate therapy x 2-3 weeks -clinical improvement of sx -3 negative sputum smears -stable or improved CXR