TB Infection Control Carol Staton, RN, BSN March 17, 2015 TB Nurse Case Management March 17 19, 2015 San Antonio, Texas EXCELLENCE EXPERTISE INNOVATION Carol Staton, RN, BSN has the following disclosures to make: No conflict of interests No relevant financial relationships with any commercial companies pertaining to this educational activity 1
TB Infection Control Objectives Identify three levels of an effective TB infection control program: Administrative controls Environmental controls Respiratory protection controls Identify when a TB patient is no longer infectious: Pulmonary TB Extra pulmonary TB Pediatric TB Multidrug resistant TB 2
Basics of Infection Administrative Control Considered to be the most important of the three levels The responsibility here is to protect the uninfected people CDC Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health Care Settings, 2005 3
Administrative Controls What is involved? Written TB Infection Control plan Assigning the responsibility Coordinating a TB risk assessment of the setting Administrative Controls What is involved? Cont Timely lab processing and reporting Ensure proper cleaning of equipment Appropriate signage advising respiratory hygiene and cough etiquette 4
Administrative Controls What is involved? Cont Training and educating health care workers at time of hire and annually Screening and evaluating HCWs Coordinating efforts with the local or state health department Environmental Controls Here we want to accomplish: Prevent spread and reduce transmission Reduce the concentration of infectious droplet nuclei Controlling the source of Infection Using our Environment! 5
Infectious Droplet Nuclei Transmission of droplet nuclei [online image] retrieved from http://respiratory supplies.medical supplies equipment company.com/flu transmission and flu prevention 576.htm Environmental Controls Environmental control designed to contain the source. I. By using ventilation to remove or lessen droplets. II. Using HEPA filtration/uv germicidal irradiation III. Respiratory Protective equipment. 6
Environmental Controls cont Natural Ventilation Mechanical ventilation Exhaust fans such as induction rooms Environmental Controls cont airborne infection isolation [AII] rooms to control the source of infection HEPA (high efficiency particulate air) filter remove about 99.7% of particles greater than 0.3 microns in diameter UV germicidal lights work by sterilizing the infectious droplet therefore reducing transmission. 7
Respiratory protection controls Respiratory protection program Training HCW as to the above. Educating patients on their own use of masks and respiratory etiquette. Respiratory Protection Controls incorporates selection of correct and approved personal respirator or disposable respirator. Maintenance of equipment and proper disposal Correct use of chosen equipment. 8
Respiratory Protection Controls: Training HCWs on respiratory protection TB Disease & Infection N95 masks or HEPA filter respirators TB transmission Airborne Isolation precautions Educating patients on respiratory protection Using face masks compliance with isolation precautions coughing/hygiene etiquette 9
Identifying when a TB patient is no longer infectious Four different scenarios: Extra pulmonary TB Pediatric TB Pulmonary TB Multidrug resistant TB 10
Extra Pulmonary TB TB in places other than the lungs Usually not infectious Unless there is Laryngeal TB or TB in open lesions or drainage fluid Examples are joints, spine (Potts disease), Lymphatic system Pediatric TB Usually not infectious Don t produce a lot of sputum 11
Pediatric TB Not likely infectious due to size of the child and their strength to be able to cough Not much sputum production However if you have a child the size of a small adult it is always better to follow requirements for an adult considered to be infectious. Pulmonary TB CDC guidelines to remove from patient from Airborne Isolation The patient produces three consecutive negative sputum smears collected in 8 to 24 hour intervals (one should be an early morning specimen). Receive standard multidrug antituberculosis treatment (minimum of 2 weeks) Clinical improvement: meaning symptoms have lessened 12
MDR TB Heartland guidelines Must meet the following: Receiving and tolerating appropriate multidrug anti TB regimen Demonstrated adherence to treatment (DOT) Demonstrated clinical improvement Have 3 consecutive negative AFB cultures* In Review Administrative Controls Controls Environmental Controls Respiratory Protection Controls 13
Pulmonary Extrapulmonary TB Extra Pulmonary Pulmonary Multidrug resistant Pediatric Pediatric Multidrug resistant Questions? 14
References California Department of Public Health, Occupational Health Branch. (2012). Implementing respiratory protection programs in hospitals: A guide for respirator program administrators. Richmond, CA. Retrieved from http://www.cdph.ca.gov/programs/ohb/documents/hcresp CARPPGuide.pdf Centers for Disease Control and Prevention (CDC) Division of Tuberculosis Elimination (DTBE). (2005). Managing TB patients: General recommendations Airborne Infection Isolation (AII) policies and practices. Retrieved from http://www.cdc.gov/tb/publications/slidesets/infectionguidelines/settings.htm Center for Disease (CDC) (2005) Guidelines for preventing the transmission of Mycobacterium tuberculosis in health care settings. MMWR 2005; 54 (No. RR 17). References Starke, J "Tuberculosis in Children", Semin Respir Crit Care Med, 2004;25(3) www.medscape.com/viewarticle/484123 Heartland National TB Center. (2011). Guidelines for home and hospital isolation of infectious tuberculosis patients. Retrieved from http://www.heartlandntbc.org/products/guidelines_home_hospital_infectious_ patients.pdf 15
References CDC Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health Care Settings, 2005 http://www.cdc.gov/mmwr/preview/mmwrhtml/00001897.htm http://www.cdc.gov/tb/education/corecurr/pdf/chapter2.pdf Starke, J "Tuberculosis in Children", Semin Respir Crit Care Med, 2004;25(3) www.medscape.com/viewarticle/484123 Heartland National TB Center. (2011). Guidelines for home and hospital isolation of infectious tuberculosis patients. Retrieved from http://www.heartlandntbc.org/products/guidelines_home_hospital_infectious_ patients.pdf https://embryology.med.unsw.edu.au/embryology/images/8/87/cdc_cover_your_cough.gif http://www.masslocalinstitute.org/onlinecourses/workforce_protection/cdc_covercgh_ view.jpg http://respiratory supplies.medical supplies equipment company.com/flu transmissionand flu prevention 576.htm http://www.healthaccessories.com/health helpers/ear loop surgical masks http://www.micomedical.com/signage/decals http://www.cdc.gov/tb/events/worldtbday/ 16