Concerns for Health Care Workers

At one time, TB in the United States had almost been eliminated. Unfortunately, because of HIV and other immune compromising diseases, it is on the rise.

Prevention is the way to control this disease. As a healthcare provider, you have an increased risk of coming in contact with someone who has the disease. The greater your exposure to a person with the disease the greater your risk is of becoming infected.

In order to protect yourself you must understood all of the following:

o How TB is transmitted

o Testing for TB infection

o Wearing personal protective equipment (PPE) when in contact with people who have TB or have been exposed to TB

o Reporting to your supervisor any possible exposure to TB

o Participating in annual PPD screening tests.

PPE and Isolation Precautions

When working in a facility with patients who have TB, PPE (personal protective equipment) should be worn according to that facility's specific policy. The policy and procedures should cover the use glove, gowns, masks, as well as the proper disposal of these items.

The mask you will be required to use for an individual with TB is different from the general type of masks used: A TB mask is called a respirator mask. It's a special fitting respirator that will not allow the tiny TB particles to enter. It has a specially designee filter and is referred to as an N95 mask.

Isolation procedures include

An acid fast bacillus (AFB) isolation card should be present, instructing the health care worker to wear a mask, wear a gown, and to use gloves for touching the patient and/or all infected article. Good hand washing is very important. Any item in the isolation room should be treated as if it is contaminated. There should be an isolation cart outside the room with proper PPE available for immediate use.

Keep in mind that the air we breathe is a positive air pressure environment. A person with TB needs to be placed in a negative air pressurized room. Negative air pressure means air flows INTO the room from the outside. The air is also filtered back to the outside, passing through specially designed filters. The air is cycled through at least six times an hour.

Remember to open doors SLOWLY to prevent air from flowing back into the building. The door must always remain closed. Wear a respirator mask when in a room that has known or suspected TB. You must be fitted for a respirator mask.

Home Care

Patients with newly diagnosed TB are placed on medication and when they are sent home, they are put on home isolation. This means they cannot go to any public places such as work, school, church or stores. How infectious a patient is, is determined b y a number of repeated tests . The tests must be negative for three days in a row before a patient is free to leave the home.

As treatment continues the patient feels much better. This means the medication is working. If the patient does not feel better after 3 weeks of medication, the medication may not be working. You should report this to your supervisor.

The local public health department tests everyone living in the home for TB. If anyone tests positive for the infection or disease they are treated with medication. The public health department does not recommend uninfected persons leave the home unless they are very young. If the patient has active lung disease, with positive tests, the home care staff should wear a N9S fit‐tested mask.

Home care staffs do not need to take any special precautions with their bags, equipment or clothing. These items do not present any TB risk to themselves or other patients.

Patients with active TB should be taught respiratory hygiene and cough precautions.

o Always cover the mouth when coughing or sneezing

o Use two Kleenex to cover the mouth

o Practice good hand washing including, after coughing, sneezing or contact with respiratory

secretions

o Avoid singing of yelling

o Family members can decrease the possibility of becoming infected by sleeping in a different room than the patient while they are contagious.

*** IMPORTANT TO REMEMBER*** It is very important that the mask fits your face without leaking. TB particles are very small and can get inside a mask that doesn't fit properly. It you must take the patient out of the room for any reason, the patient is to wear a REGULAR SURGICAL MASK, NOT A RESPIRATOR TYPE N95, LIKE YOU WEAR TO ENTER THE ROOM!!! This is because the respirator N95 mask ONLY filters INHALED air NOT EXHALED AIR.