TB Infection Control Delvina Mimi Ford, BSN, RN, CCRN K March 7, 2017 TB Nurse Case Management March 7 9, 2017 San Antonio, TX EXCELLENCE EXPERTISE INNOVATION Delvina Mimi Ford, BSN, RN, CCRN K 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 Presented by: Delvina Mimi Ford, BSN, RN, CCRN-K Infection Preventionist with Brooke Army Medical Center / San Antonio Military Medical Center Photo Credit: CDC photo library PHIL ID #9997 Photo Credit: www.microbiologyinpictures.com Delvina Ford, BSN, RN, CCRN-K has the following disclosures to make: No Conflict of Interests No financial relationships with any commercial companies pertaining to this educational activity. The view(s) expressed herein are those of the author(s) and do not reflect the official policy or position of Brooke Army Medical Center, the U.S. Army Medical Department, the U.S. Army Office of the Surgeon General, the Department of the Air Force, the Department of the Army or the Department of Defense or the U.S. Government. 2
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 Multidrug resistant TB Extra-pulmonary TB Pediatric TB Environmental Administrative Respiratory- Protection Administrative In place to REDUCE RISK Assigning responsibility for TB infection Control TB Risk Assessment TB risk assessment: http://www.cdc.gov/tb/publications/guidelines/appendixb_092706.pdf Written plan Detection Airborne precautions Treatment of possible or confirmed Administrative 3
Administrative Potentially contaminated equipment Cleaning Disinfection Sterilization Timely Availability Lab processing Testing Results Photo Credit: CDC photo library PHIL ID #9997 Administrative Training & Education of HCWs (Health Care Workers) Prevention Transmission Symptoms Screenings/Evaluations of those at risk or potential for exposure 4
Administrative Epidemiologic prevention principles. Appropriate Signage Respiratory hygiene Cough etiquette Coordinating Efforts Local health department State health department Photo Credit: http://www.health.state.mn.us/divs/idepc/dtopics/infectioncontrol/cover/hcp/hc pposter.html IC#141-1428 Environmental DF o Primary Controlling the Source Local exhaust ventilation Diluting/removing contaminated air 2016 Environmental Administrative Photo Credit: http://www.flanders-csc.com/tb.htm o Secondary AII (airborne infection isolation room) Airflow Cleaning using HEPA/UV Photo credit: https://www.prlog.org/10226208-sanuvox-uv-airsterilization-systems-ability-to-destroy-airborne-influenza-includingswine-flu.html 5
AII Room DF 2016 12 Air changes per hour (ACH) and direct exhaust of air from the room to the outside of the building. Photo credit: Core Curriculum on Tuberculosis, 2013 Chapter 7 Tuberculosis Infection Control Page 207 Respiratory protection controls Reduce Risk for health care workers Implementation of a respiratory protection program Training HCWs : assign responsibility, train, Environmental fit testing (OSHA Appendix A to 1910.134: Fit Testing Procedures (Mandatory) Educating patients on respiratory hygiene and Cough etiquette Administrative Respiratory Protection Photo credit: http://www.cdc.gov/tb/topic/infectioncontrol/default.htm 6
Identifying when are we no longer contagious? http://www.cdc.gov/tb/education/corecur r/pdf/chapter2.pdf Photo credit: http://www.cdc.gov/tb/education/corecurr/ pdf/chapter2.pdf 7
Pulmonary TB & MDR TB DF 2016 CDC Guidelines 2005-Suspected TB Role out Another diagnosis is made that explains the clinical syndrome Three consecutive, negative AFB sputum smears, Each of the three sputum specimens collected 8-24 hour intervals At least one specimen from early morning (respiratory secretions pool overnight) 8
CDC Guidelines 2005-Confirmed TB Release from AII Three consecutive negative AFB sputum smear results, each collected in 8-24 hour intervals At least one being an early morning specimen Standard multidrug anti-tuberculosis treatment (minimum of 2 weeks) Demonstrated clinical improvement Extrapulmonary TB DF 2016 Larynx, lymph nodes, pleura, brain, kidneys or the bones and joints. Other than the lungs: Photo credit: https://commons.wikimedia.org/wiki/file:extrapulmonary_tuberculosis_symptoms.png 9
Extrapulmonary TB-draining lesion Usually not Infectious unless: 1. Pulmonary disease in addition to 2. it is located in the oral cavity or the larynx 3. includes an open abscess or lesion in which the concentration of organism is high or if drainage fluid is aerosolized. Discontinue precautions only when patient is improving clinically, and drainage has ceased or there are three consecutive negative cultures of continued drainage. CDC Appendix A 2007 Guideline for Isolation Precautions. Pediatric TB DF 2016 TB disease in a person < 15 years of age Children with tuberculosis are rarely contagious, but their caregivers may be. Isolate children of any age with adult type disease for example extensive infiltrates, sputum production, or cavity on chest x-ray should be isolated when in health care facilities until it can be determined that they are not infectious. CDC TB guidelines 2005 10
Review TB Infection Control Administrative -written policy Environmental -Ventilation Respiratory -N95 Masks Release from Airborne Precautions: 3 negative sputum smears, 8 hours apart, 1 from the morning 2 weeks of effective therapy Clinical improvement Questions? Levi Bubba Ford Sweetest Chocolate Lab ever 11
References Bartley, J. (2014). APIC text of infection control and epidemiology: Heating, ventilation, and air conditioning (4th ed.). Washington, D.C.: Association for Professionals in Infection Control and Epidemiology. Cadena, J. A. (2014). APIC text of infection control and epidemiology: Tuberculosis and other mycobacteria (4th ed.). Washington, D.C.: Association for Professionals in Infection Control and Epidemiology. CDC. Core curriculum on tuberculosis: What the clinician should know (6th ed.). (2013). Atlanta, GA: U.S. Dept. of Health & Human Services, Centers for Disease Control and Prevention, National Center for HIV, STD, and TB Prevention, Division of Tuberculosis Elimination. http://www.cdc.gov/tb/education/corecurr/pdf/chapter2.pdf CDC. Guidelines for preventing the transmission of Mycobacterium tuberculosis in healthcare settings, 2005. MMWR 2005; 54 (No. RR-17). www.cdc.gov/mmwr/preview/mmwrhtml/rr5417a1.htm?s_cid=rr5417a1_e Cruz, A. T., Medina, D., Whaley, E. M., Ware, K. M., Koy, T. H., & Starke, J. R. (2011). Tuberculosis among families of children with suspected tuberculosis and employees at a children's hospital. Infection Control & Hospital Epidemiology, 32(2), 188-190 3p. doi:10.1086/657940 Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee, 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, Appendix A. Retrieved on July 6 th 2016 from http://www.cdc.gov/ncidod/dhqp/pdf/isolation2007.pdf Starke, J.R. (2004). Tuberculosis in children. Seminars in Respiratory and Critical Care Medicine, 2004;25 (3). Retrieved on July 1, 2016 from http://www.medscape.com/viewarticle/484123_2 References OSHA Appendix A to 1920.134 Fit Testing Procedures Mandatory protocols. Retrieved on July 8, 2016 from https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=standard S&p_id=9780 12