OSHA Blood Borne Pathogen and Tuberculosis Training PART II Tuberculosis Author: Maxine Edwards, RN, ICP ECU Infection Control Presented by: Patti Goetz, RN ECU Infection Control

Tuberculosis Airborne Pathogen Old Enemy New Battle

TB Trends by Case Rate Per 100,000 Population

TB in NC and Pitt Co =335 cases reported in NC, ranking NC 22 nd in the nation 2004= 7 cases 2006= 6 cases 2007 = 11 cases reported in Pitt Co.

MTB Cases in NC YearNC Pitt Co. ECU

TB Cases by NC County 2007 Number

High Risk for TB in NC 2007 HIV: 9% (2006= 5%) Homeless: 4% (2006=5%) Alcohol abuse: 12% (2006=17%) Foreigners: 41% (2006=36%) Health care workers: 1% (2006=2%) Close living conditions (prisons, nursing homes) : 5% (2006=6%)

Airborne Spreads when someone with active TB disease coughs, talks, laughs, sneezes, or spits TB bacteria into the air Uninfected person breathes in TB bacteria Transmission

Fever, chills Night sweats Fatigue and weakness Cough > 2 weeks Thick, cloudy or bloody sputum Decreased appetite and weight loss Shortness of breath and chest pain Signs & Symptoms

LATENT TB INFECTION ACTIVE TB DISEASE Exposed to active TB disease, bacteria enters body but is controlled Infection has progressed to active disease, bacteria are multiplying Positive TB skin test No symptoms Will have symptoms Negative CXR Positive CXR WILL NOT INFECT OTHERS WILL

A TB skin test or PPD will show if you have any TB bacteria in your body. All employees or students that are potentially exposed to TB need to receive a skin test annually. How do we test for TB?

If patients have symptoms of TB, offer tissues and surgical masks. Escort patients to the nearest “negative pressure” room to isolate them. Patient should wear mask outside room and during transport to other departments All health care workers who work with potential TB patients should wear appropriate PPE when working with infectious individuals. How do Healthcare Workers avoid exposure to TB?

Remember your size Fit testing will be done annually for those performing high risk procedures Others will be done every 5 yrs unless there are facial changes. You will be asked about changes at your annual health update N-95 Respirator

Notify Prospective Health of facial changes: large amount of weight gain or loss facial trauma and/or surgery growth or shaving of beard If unable to wear mask, you will be instructed in the use of a PAPR N-95 Respirator

Power Air-Purifying Particulate Respirators (PAPR)

What if I have Latent TB Infection? 90% of healthy people with TB infection will never develop TB disease. Should be evaluated for prophylactic medications by the health department or a private physician. Prophylaxis meds reduce lifetime risk of developing active TB disease by 95% Be aware of signs and symptoms of active TB disease

You will receive antibiotics which will eventually kill the TB bacteria in your body You may return to work when no longer infectious (usually 2-3 weeks after starting antibiotics) What if I am diagnosed with TB disease?

Treat and Prevent TB Must take antibiotics as directed for active TB disease Treatment directly observed by county Health Dept. It’s the Law!

When can I return to work if I develop active TB disease? Once evaluated by Prospective Health When you are no longer infectious -appropriate therapy x 2-3 weeks -clinical improvement of sx -3 negative sputum smears -stable or improved CXR