OSHA Tuberculosis Training This module is for any associate who needs TB training

This computer-based learning course… Examines tuberculosis (TB) infection control. Describes Occupational Safety and Health Administration (OSHA) regulations and the respiratory protection program. Outlines steps to take if you are exposed to TB Briefly describes what tuberculosis is and how it affects the body.

Guidelines and Goals The Occupational Safety and Health Administration (OSHA) publishes and enforces national guidelines for TB infection control. The primary emphasis of the TB Exposure Control Plan is to achieve three goals: Early detection Prompt isolation Prompt treatment

What Is Tuberculosis? Tuberculosis (TB) is an infectious disease caused by a microorganism (germ) called Mycobacterium tuberculosis. TB usually affects the lungs (pulmonary TB) but it can also affect other parts of the body (e.g. brain, kidney, spine, etc.) Tuberculosis –Growth of the TB Germs in the lungs causes tissue destruction and the development of signs and symptoms such as cough, weight loss, bloody sputum, or persistent fever.

How Does TB Disease of the Lungs Spread from Person to Person? Pulmonary TB spreads from the lungs of an infected person to another person through the air when Coughing Sneezing Singing Talking Or anytime air is forcibly expelled from the lungs. People can become infected when they breathe in air containing TB germs.

What Happens When A Person is Exposed and Infected with TB? Once infected, TB may remain dormant in the body while the immune system is strong. TB disease may develop later as the immune system slows down, or the exposed person may never develop active disease. The risk of progressing to active disease is estimated to be 5 – 10% A person may develop active TB disease: shortly after inhaling the TB germ later in life never develop

TB Disease The usual symptoms of TB disease are Productive cough lasting several weeks Weight loss Fever Night sweats Fatigue Shortness of breath

TB Disease Persons with TB disease of the lung are frequently capable of spreading the infection to others. For this reason, they are placed in specially ventilated isolation rooms in the hospital. TB disease can usually be treated with a course of 3 or 4 anti-tuberculosis drugs.

TB Infection Persons who have the TB germ in their body but do not have active TB disease will have a positive TB skin test These persons have TB infection, but not TB disease. Persons with TB infection without TB disease are not usually sick and do not require isolation. These persons are often prescribed a course of one drug anti-tuberculosis treatment to prevent them from developing the disease.

Certain people are more likely to develop active tuberculosis because of their living or health conditions. Some of these are: Elderly Persons living in under- developed countries Alcoholics Intravenous drug user (IVDU) Homeless persons People with chronic diseases

In addition, persons with certain medical conditions including HIV, cancer, and diabetes are at a higher risk of developing active TB disease if infected.

Diagnosis of Tuberculosis Persons suspected of having TB are evaluated in the following ways: A physical examination A tuberculin skin test (sometimes called a PPD) A chest x-ray A sputum smear and culture. PPD –A positive PPD (or TB) skin test is a reaction to the material injected into the skin. This reaction suggest that the individual has been infected with the TB germ.

Control the Spread The best way to control the spread of TB in the hospital is early identification of patients with disease and appropriate isolation and treatment. These patients should wear a mask if unable to cover their mouth/nose when coughing and moved from public areas quickly.

Isolation Guidelines Upon admission to the hospital, patients with respiratory illness are routinely asked questions to determine if they have signs and symptoms which might indicate tuberculosis. If signs and symptoms of TB are present, isolation may be ordered by the physician, Infection Control, charge nurse, or Nursing Supervisor. The isolation category for TB is called “Airborne Precautions”. These patients should remain in isolation until the diagnosis of TB has been ruled out, or until condition improves.

Airborne Precautions Patients requiring isolation for TB are placed in specially ventilated rooms. These rooms are designated by a blue dot on the room sign. Some rooms may also have a negative pressure gauge visible outside the room. These rooms have : 100% of air exhausted to the outside Lower air pressure inside the room when compared to the air pressure in the hallway (called “negative pressure”). An increased number of air changes per hour (ACH)

Airborne Precautions Room ventilation must be checked daily when a patient is isolated. Plant Engineering is prompted by the “Airborne isolation” order to do daily checks for negative pressure. It is important to keep the door to the room closed except for entry and exit. Transfers to isolation rooms must occur within five hours of the order for isolation. While awaiting transfer, the patient should wear a surgical mask and be placed in an area that will reduce exposure to others. Students should not be assigned to care for patients in isolation. Isolation information must be entered into EPIC.

Airborne Precautions All hospital personnel entering the isolation room must wear a N95 respirator or a PAPR (Powered Air Purifying Respirator) . The respirator fit testing program is managed by the Employee and Business Health Departments. Initial and annual evaluations are required.

N95 Respirator N95 respirators are only effective if there is a tight seal around the nose and mouth Personnel must be “fit tested” for their proper fit and receive instruction prior to use of respirator A”user seal check” must be performed each time an N95 respirator is used.

Persons with facial hair cannot be appropriately fitted to an N95 respirator and must use a PAPR and hood instead.

PAPR & Hood Personnel must receive instruction in the use of the PAPR prior to wearing the equipment. PAPRs and hoods are kept in the SPD Department . Hoods may be re-used by the same person but not shared with others.

Cough or Respiratory Etiquette Patients should be instructed to use “Cough or Respiratory Etiquette” Cover mouth and nose with tissues (or sleeve) when coughing or sneezing Dispose of used tissues in the trash Perform hand hygiene Patients in “Airborne Precautions” must wear a surgical mask if they leave their room. Transport should be limited to essential purposes only.

When is a TB patient no longer infectious? Patients are no longer considered infectious (capable of spreading to another person) when Their cough subsides Sputum smears are negative Condition improves This usually happens within 2 weeks after receiving 3-4 drug therapy. The physician and hospital policy determine when the isolation precautions are discontinued. After discharge of the patient, the room generally should remain closed and unused for one hour. The isolation sign should remain on the door to the room during this time, and persons should not enter without respiratory protection.

Routine Testing of Healthcare Workers Employee Health performs TB Skin tests or medical evaluations on an annual basis for hospital associates with potential exposure. Persons who know they have positive skin tests are not tested but must complete an annual survey.

Exposure to TB If you are concerned about an exposure to an un-isolated patient with TB: Notify Employee Health or Infection Control Follow their recommendations for suggested treatment and follow-up testing

Exposure to TB (cont’d) Follow the Tuberculosis Exposure Control Plan. Available on the Intranet under Policy and Procedures. For more information about tuberculosis, contact the Infection Control Department. Edgewood - 1- 2155 Florence - 2-4399 Ft Thomas - 2-3688

Conclusion We hope this Computer Based Learning course has been both informative and helpful. Feel free to review this course until you are confident about your knowledge of the material presented. Once you are comfortable with the material, you may proceed to the test in order to receive credit for course completion.