OSHA
Blood Borne Pathogen
and
Tuberculosis Training
PART II Tuberculosis
Author: Maxine Edwards, RN, ICP
ECU Infection Control
Presented by: Patti Goetz, RN
ECU Infection Control
Tuberculosis
Airborne Pathogen
Old Enemy
New Battle
World Epidemiology 2007
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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
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Six countries in Asia account for more
than 50% of TB epidemic
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India
China
Bangladesh
Pakistan
Indonesia
the Philippines
TB Trends by Case Rate
Per 100,000 Population
TB in NC and Pitt Co 2007
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2007=335 cases reported in NC,
ranking NC 22nd in the nation
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2004= 7 cases
2006= 6 cases
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2007 = 11 cases reported in Pitt Co.
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MTB Cases in NC
Year
NC
Pitt Co.
ECU
2005
329
5
4
2006
374
5
8
2007
345
11
11
TB Cases by NC County 2007
Number
18-54
8-17
3-7
0-2
High Risk for TB in NC
2007
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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%)
Transmission
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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
Signs & Symptoms
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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
LATENT TB
ACTIVE TB
INFECTION
DISEASE
Exposed to active TB
disease, bacteria
enters body but is
controlled
Positive TB skin test
Infection has
progressed to active
disease, bacteria are
multiplying
Positive TB skin test
No symptoms
Will have symptoms
Negative CXR
Positive CXR
WILL NOT
INFECT OTHERS
WILL
INFECT OTHERS
How do we test for TB?
•
•
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.
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
How do Healthcare Workers
avoid exposure to TB?
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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.
Personal Protective Equipment (PPE)
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OSHA requires the use of approved, certified
respirators for respiratory protection
N-95 particulate respirator or Power Airpurifying 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
N-95 Respirator
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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
Power Air-Purifying Particulate
Respirators (PAPR)
What do I do if I am
exposed to TB ?
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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.)
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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?
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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
What if I am diagnosed
with TB disease?
You will receive antibiotics which will
eventually kill the TB bacteria in your
body
You may return to work when no longer
infectious (usually 2-3 weeks after
starting antibiotics)
Treat and Prevent TB
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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?
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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