Transcript OSHA/Tuberculosis Training

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 antituberculosis 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 underdeveloped 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 followup 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.