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TUBERCULOSIS
& AIRBORNE
ISOLATION
Objectives:
Define
TB
Identify
Symptoms of TB
Identify Prevention Measures
What
is TB?
Tuberculosis (TB) is a bacterial disease usually affecting the lungs (pulmonary TB) caused by Mycobacterium Tuberculosis. Other parts (extra pulmonary TB) can also be affected; such as brain, lymph nodes, kidneys, bones, larynx, intestines or eyes.
Who gets TB?
The bacteria causing TB spreads through the air by airborne particles called droplet nuclei. When a person with TB, who is not on the appropriate medication, coughs or sneezes, germs get into the air. Prolonged exposure to the TB bacteria is normally necessary for the infection to occur.
What
is the Difference Between TB Infection and TB Disease?
TB
infection may result after close contact with a person who has TB disease.
TB
infection
is determined by a significant reaction to the Mantoux skin test with no
symptoms
of TB and no TB bacteria is found in the sputum. TB disease
is
characterized
by the appearance of symptoms, a significant reaction to a Mantoux skin
test and TB bacteria if found in the sputum.
To spread the TB bacteria, a person must have TB disease.
Having TB infection is not enough to spread the bacteria. TB may last a
lifetime as an infection and never develop into the disease. TB disease is
most likely to develop during the first 2 years after acquiring the
infection. Additionally, individuals with weakened immune systems, such as
persons infected with HIV, are at high risk of developing TB disease if TB
infection is untreated.
What
are the Symptoms of TB?
The symptoms of TB include low-grade fever, night sweats, and fatigue, weight loss and a persistent cough. Some people may not have obvious symptoms.
How
Soon Do Symptoms Appear?
Evidence
of infection (a positive skin test) may occur 4 –12 weeks after
exposure. The most common period for developing clinical disease is 12-24
months after infection. Infection can remain latent with the disease
occurring much later in life.
When
and For How Long is a Person Able to Spread TB?
A
person with TB disease may remain contagious until he/she has been on
appropriate
treatment for several weeks. It is important to note that a person with TB
infection, but not disease, cannot spread TB to others, since there
is no TB bacteria in the sputum.
What
is the Treatment For TB?
People
with active TB disease must complete the prescribed course of medicine,
which
usually involves taking medications for 6-12 months. TB infection is not
treated
with isoniazid alone; treatment of TB disease usually requires three or
more drugs. A physician must determine the exact medication plan.
What
Can Be the Effect of Not Being Treated For TB?
In
addition to spreading the disease to others, an untreated person may
become severely ill or die. (Source for the above information came from
the Ohio Department of Health.)
MMH
and Washington County have an extremely low incidence of TB.
If the disease occurs, immediate coordination with local and state
health departments is initiated.
**MMH
Fact--The last time we know of a person with TB disease who was cared
for at MMH was in 2004
As a caregiver you are at increased risk for exposure to TB. You have the responsibility of seeking medical evaluation if you have symptoms of TB or have a positive PPD skin test. The Joint Commission on the Accreditation of Hospital Organizations requires annual PPD testing for all employees with direct patient contact. Notify your supervisor if you are diagnosed with TB. The hospital has the responsibility of maintaining your confidentiality while ensuring you receive proper treatment and are non-infectious when you return to work.
If you have a
weakened immune system that puts you at increased risk of contracting TB,
advise your supervisor or Employee Health to se if work reassignment is
warranted.
Prevention
TB
disease is preventable through screening, using the PPD skin test (Mantoux)
which is administered by the Out Patient Center or Employee Health.
Employee Health, the lab or trained nurse managers must read the PPD
within 48-72 hours.
Because our risk of TB is low, we no longer require an annual TB test for employees.
Persons
admitted to the hospital with suspected or confirmed TB are placed in Acid
Fast Bacilli (AFB) isolation immediately. A nurse may place a suspected TB
patient in isolation and obtain a physician order later. The AFB isolation
rooms have negative pressure and are located on Division B in room 354 and
on Division. G room 259. There are also two portable negative pressure
machines that are available for use in other rooms. Patients in TB
isolation should remain in the isolation room with the door closed.
Negative pressure rooms are also available in the ED (Rooms 18 & 19)
and on the Pre/Post Unit (Rooms #1 & #2). Patients in TB isolation
should remain in the isolation room with the door closed.
All persons entering the TB isolation room or other rooms with suspected or known TB patients should wear respiratory protection. The number of persons entering TB isolation should be kept to a minimum.s a positive sputum smear ot
Transportation
Treatments and procedure should be performed in the isolation
room whenever possible to avoid transportation of the patient.
If a patient must be transported outside the isolation room, he/she
must wear a surgical-type mask during the transport.
Transporters do not wear a respirator while transporting the
masked patient in the halls.
Tuberculosis (AFB) Isolation (Airborne Precautions)
This is an isolation category for patients with pulmonary TB who
have a positive sputum smear or a chest X-ray that strongly
suggests current (active) TB. Laryngeal TB is also included in this isolation category. In general, infants and young children with pulmonary TB do not require isolation precautions because they
rarely cough, and their broncial secretions contain few AFB, compared with adults with pulmonary TB. On the isolation card,
this category is called AFB (for acid-fast bacilli) isolation to
protect the patient's privacy.
Diseases Requiring Airborne Precautions
1.
Place the patient in a private room which has:
a.
Monitored negative air pressure in relation to surrounding areas
b.
6-12 air exchanges per hour
c.
Appropriate discharge of air outdoors or monitored high-efficiency
filtration of room air before it is circulated to other areas of the
hospital
d.
Keep room door closed and patient in the room
e.
In general, patients with the same organism may share a room, but with
no other infection (co-hosting)
2.
Nursing notifies Maintenance and CPT that a room is
needed for airborne
isolation
On
Div. B a monitor is behind nurses station and on Div. G the gauge is just
outside
the
negative pressure room and can be viewed from the nurses station (gauge
has
upper/lower
limits). The gauge has an audible alarm and it also has a light,
which
will not shut off until the room has negative pressure.
*
CPT will provide documentation of service and daily pressure readings.
*
Portable negative pressure machines with gauges may be used in other
areas.
3.
Respirators are indicated for all employees entering the room. All
employees
must
first be tested prior to wearing a respirator and must have training in
the
proper
use and maintenance of respirators.
4.
Visitors should be limited and should wear a mask when entering the room.
5.
Limit the movement and transport of the patient from the room to essential
purposes
only. Patients are to wear a
mask when being transported from the room.
6.
Gowns are indicated only if needed to prevent gross contamination of
clothing.
Gloves
are not indicated.
Note:
Additional precautions for preventing transmission of TB: Gowns are
indicated
only if needed to prevent gross contamination of clothing.
Frequently
AFB is used interchangeably with Airborne Isolation. However,
Airborne
Isolation covers all respiratory diseases that can be transmitted
via air and
AFB isolation is specific to TB only.
Respiratory
Protection for Employees Working with Patients with Suspected or Confirmed
TB
• The
OSHA regulations have caused some changes in the respiratory
protection
plan. Annual fit testing of employees who wear respirators will
be
done by Employee Health prior to issuing the respirator.
• Any
employee who enters a TB isolation room must be medically evaluated
and
fit tested with an approved respirator prior to entering the room.
• The
wearer must inspect the respirator before it is put on, and must be
worn
each time the room is entered.
• The
employee must check the respirator prior to entering the room and
dispose
of or properly store the respirator after use.
• If the
employee has had a significant weight gain or loss (10 pounds or more)
or
change in facial structure, he/she should repeat the respirator fit
testing.
Important
Information for Respirator Wearers
Steps You
Can Take to Protect Yourself
Important
Information for Respirator Wearers
Steps You
Can Take to Protect Yourself
• Check the
respirator before putting it on to ensure there is no damage or
tears and that
the straps are in good condition.
• Put the
respirator on, fitting it to your chin first and position straps properly.
• Mold the
nosepiece to your nose after the straps are positioned. DO NOT PINCH AT
THE BRIDGE OF THE NOSE as this will cause a leak. Take a deep breath
and blow out through your mouth.
• Perform the
face fit check prior to entering the isolation area.
• To remove,
support the respirator in your hand while removing the straps.
• If at any
time you question the effectiveness of your respirator, leave the area
• Your
respirator is disposable, but may be used more than once.
• Your
respirator may be stored in a paper bag in a dry place, out of the
direct
• Discard your
respirator at the end of the day, or sooner if wet or damaged.
• Replacement
respirators are available on each department or may be ordered
Marietta
Memorial Hospital recognizes its responsibility to protect
DON'T FORGET TO TAKE THE QUIZ!