POLICY FOR THE PREVENTION AND CONTROL OF TUBERCULOSIS Policy No: 7.20 Approval Date: Review Date: Lead Director: Under Review Under Review Under Review Page 1 of 7 Polic y_for_the_prevention_and_control_of_tuberculosis
POLICY FOR THE PREVENTION AND CONTROL OF TUBERCULOSIS Introduction This policy is designed to give information to staff nursing patients with suspected or confirmed pulmonary tuberculosis. Further information can be obtained from the sources referenced. Information Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis and rarely Mycobacterium bovis. Tuberculosis is a notifiable disease (see Section 6). Cases of tuberculosis are formally notified to the Consultant in Communicable Disease Control (CCDC). The CCDC informs Shelton Chest Clinic. The treatment of all patients with tuberculosis will be managed by the Chest Physicians or the Infectious Diseases Physician. Most people with tuberculosis are treated at home. For practical purposes an infectious person is one in whose sputum tubercle bacilli are present in sufficient numbers to be seen on direct examination of sputum smears. Patients with pulmonary tuberculosis in whom three or more specimens obtained on three consecutive days give negative results on direct smear examination should be regarded as non-infectious. Non-pulmonary tuberculosis is not infectious. Safe working practice when dealing with body fluids is always important. Staff Protection The best protection against tuberculosis is for staff to have their own immunity. The Occupational Health Department ensure this by pre-employment skin testing and the administration of BCG vaccine where appropriate. Staff at "increased risk" are screened annually. The "increased risk" category includes staff who are in regular contact with patients known to have tuberculosis or laboratory workers who handle potentially infective material. Staff exposed to possible infectious tuberculosis, as defined by the Infection Control Team, will be checked by the Occupational Health Department. Page 2 of 7 Polic y_for_the_prevention_and_control_of_tuberculosis
*Further details can be found in The Control of Tuberculosis in NHS Employment in North Staffordshire District Policy for Prevention and Control of Tuberculosis Appendix VII. Protection of other patients and visitors Other patients and visitors will not necessarily have immunity to tuberculosis and some patients e.g. the immuno-compromised may be particularly susceptible to infection. For their protection it is necessary to isolate the infectious patient. Visitors should as far as possible be limited to those who have already been in contact with the patient before diagnosis. All patients with suspected or confirmed respiratory tuberculosis, whatever the sputum status should be nursed in a single room. Under no circumstances should these patients be admitted to an open ward or bay containing a significant number of severely immuno-compromised patients such as HIV infected, transplant or oncology patients unless cleared as non-infectious by the physician in charge in consultation with the Infection Control Doctor. If a patient who has been nursed on an open ward or bay is found to have tuberculosis and is sputum smear positive, the other patients in the bay or ward may have to be followed up. The Infection Control Team will liaise with Shelton Chest Clinic regarding the follow up of these patients. Procedures which induce excessive coughing and generate aerosols e.g. sputum induction and bronchoscopy must not be carried out in open wards or bays. Isolation precautions for patients with confirmed or suspected Pulmonary Tuberculosis 1. The Infection Control Team should be informed of any sputum smear positive patients in the hospital. 2. The patient should be nursed in a single room with a toilet, washing facilities and if possible negative pressure ventilation. If a negative pressure room is not available the door must be kept closed. A notice must be placed on the door asking visitors and staff to report to the nurse looking after the patient, in order that the appropriate infection control precautions can be followed. 3. Staff caring for the patient should be kept to a reasonable minimum without compromising patient care. Page 3 of 7 Polic y_for_the_prevention_and_control_of_tuberculosis
4. Aprons and gloves should be worn for contact and when handling body fluids. On leaving the room protective clothing should be removed and hands washed. 5. Staff should wear masks when direct exposure to respiratory secretions is unavoidable e.g. sputum induction, bronchoscopy and dental surgery or for prolonged care of a high dependency patient. A good disposable theatre-type dust mist mask or High Efficiency Particulate Air (HEPA) filtering mask should be used e.g. Tecnol PFR 95. 6. Sputum smear positive patients should wear a well fitting theatre-type mask when walking or being transported through public or patient areas. 7. Patients should receive active training and supplies to ensure they cough into tissues, which must be disposed of immediately, or use a sputum container that should be covered with a lid when not in use. 8. Disposable suction jars or liners must be used. 9. Sputum containers should be handled with care and disposed of as clinical waste. 10. Crockery and cutlery should be washed in a dishwasher. 11. Equipment and surfaces should be cleaned with a clear soluble phenolic (Disinfection Policy- Section 8). 12. Staff should clean the room last (see Isolation Policy- Section 5). 13. Specimens should be transported in appropriate containers and labelled "Danger of Infection" (see Specimen Collection & Transport - Section 18). Termination of Isolation Precautions It is necessary to continue these isolation precautions until two weeks after the commencement of effective antibiotic therapy. In some circumstances 3 negative sputum smear examinations should be confirmed before removing a patient from isolation e.g. If the patient is thought to have been particularly infectious i.e. known to have transmitted infection to more than 10% of close household and/or casual contacts. If drug resistant disease is possible or confirmed. Page 4 of 7
If the patient is to be transferred to an open ward or bay containing HIV positive or immuno-compromised patients. Contact tracing Contacts of the infected person will be traced and interviewed by staff from Shelton Chest Clinic. Treatment/Discharge planning Antibiotic treatment must continue for several months. Non compliance with the treatment regime will result in failure to eradicate the tubercle bacilli and it may also result in the emergence of resistant organisms. If staff think that non-compliance is likely, advice should be sought from Shelton Chest Clinic. Resistant Mycobacteria Resistant strains of Mycobacterium tuberculosis are emerging in some countries including the United Kingdom. Additional precautions may be required for patients who are infected with resistant micro-organisms. Advice can be obtained from the Infection Control Nurses and the Consultant Microbiologist Page 5 of 7
References British Thoracic Society 1994, Control and Prevention of Tuberculosis: a code of practice. Joint Tuberculosis Committee, United Kingdom Code of Practice 1994. Thorax 1994:49, 1193-1200. Department of Health & Welsh Office 1996, Guidance on Tuberculosis Control. The Interdepartmental Working Group on Tuberculosis. Protection of Health Care Workers against Tuberculosis. Occupational Health document number 2; Appendix 1. The Control of Tuberculosis in NHS employment North Staffordshire Policy on Prevention and Control of Tuberculos. Page 6 of 7
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