Understanding TB

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Understanding TB
2009 Clinical Mandatory Education Infection
Control
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Infection Control Resources
OSHA (Occupational Safety and Health
Administration) states that Associates must have
direct access to a qualified trainer for
questions they may have while completing self
study education. Please use the following
resources, listed below, in the event you have
questions regarding Infection Control practices.
Contact your Manager/Supervisor Sharon
Selby, Manager X11695 Pager 1806 Deirdra
Pearce IC Practitioner X11407 Pager
2582 Stephanie Combs IC Practitioner X11553
Pager 1186
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Understanding Tuberculosis

• This computer-based learning (CBL) course
  examines what tuberculosis (TB) is, how it
  affects the body, and how it is transmitted. It
  compares latent and active TB and describes
  tuberculosis diagnosis and treatment plans. It
  also outlines steps to take if you are exposed to
  TB.

Causes of TB Signs and Symptoms Diagnosis and
Treatment Airborne Isolation Definitions Education
al Resources
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What Causes Tuberculosis?
Tuberculosis (TB) is a disease caused by the
microorganism Mycobacterium tuberculosis.

• TB usually affects the lungs, but it can also
  affect other parts of the body as well.
• TB is spread through the air by coughing,
  sneezing, talking, etc.
• A person may develop active TB disease shortly
  after exposure to the TB germ.
• TB may remain silent (latent) while the immune
  system is strong, but may become active TB as the
  immune system slows down.
• Most people only have a 5-10 of getting active
  disease in their lifetime.
• People with latent TB infection have the germ
  that causes TB in their bodies, but they are not
  contagious or sick. They often receive treatment
  to prevent active disease.

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Who is at risk?

• Certain groups of people are more likely to
  develop tuberculosis
• people born in areas of the world where TB is
  more common (e.g. Asia, Africa, the Caribbean,
  and Latin America)
• alcoholics
• the homeless
• IV drug users
• the institutionalized
• the elderly
• people with chronic diseases, such as HIV, cancer
  diabetes

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Active Tuberculosis

• People with active TB disease feel sick and are
  contagious.
• Patients are prescribed drugs that can usually
  cure TB.

Signs and symptoms of Active TB disease include

• Weight loss
• Fever
• Night sweats
• Coughing for more than 3 weeks
• Chest pain
• Coughing up blood (Hemoptysis)

Chills Difficulty breathing Shortness of
breath Fatigue Abnormal x-ray Loss of
appetite
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Diagnosis Evaluation
Evaluate persons suspected of having TB disease
in the following ways

• a physical examination (signs/symptoms, TB
  risk)
• a Mantoux tuberculin skin test (sometimes
  called a PPD)
• a chest x-ray
• a sputum smear and culture.

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Diagnosis Physical Exam

• A physical exam offers the first opportunity to
  check for TB.
• Note if the patient has signs and symptoms of TB.
  
• Is the patient in a group that is at risk for TB?
  
• Does the patient have a medical condition that
  predisposes him to develop active TB disease?

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Diagnosis TB skin test

• The Mantoux tuberculin skin test determines if a
  person has been exposed to TB.
• It does not tell you if a person has active TB
  disease.

• Those testing positive for TB should not
  routinely have another tuberculin skin test
  because of a higher than normal risk of more
  severe local reaction.
• Associates testing positive for TB should never
  have another tuberculin skin test unless advised
  by Health Wellness and/or their family
  physician.

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Diagnosis Chest x-ray

• Chest x-rays are an important diagnostic tool,
  but cannot be used alone to definitively diagnose
  TB.

Diagnosis Sputum smear and culture test
The sputum smear and culture test is the only
definitive test for TB. It shows if acid-fast
bacilli (AFB) are present. If the smear is
positive, the physician takes this into account
in making a diagnosis. Presence of AFB on a smear
does not definitely indicate TB. The culture
is needed for absolute identification and may
take up to 12 weeks to grow.
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Treatment Plan

• The drug used to treat latent TB infection is
  Isoniazid (INH) which is also used in
  combination with other anti-tuberculosis drugs to
  treat active TB disease.
• It is normally taken for 6 to 12 months and must
  be taken exactly as prescribed.
• Many of today's TB bacteria are multi-drug
  resistant.
• The drugs usually prescribed for TB are not
  effective against the TB germ because of patients
  who take medication incorrectly or who stop
  taking the medication too soon.
• Anyone contracting TB from a person with
  multi-drug resistant TB will also have
  multi-drug resistant TB.

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Respiratory Protection Plan

• OSHA requires, by law, all healthcare personnel
  entering an Airborne Isolation room must be fit
  tested and wear a fitted N95 respirator or
  Powered Air Purifying Respirator (PAPR).
  Associates must be fit-tested annually within one
  year of previous fit testing.
• Regular surgical masks do not adequately protect
  workers from TB.
• N95 respirators must be fitted to your face and
  tested for leaks by exhaling and inhaling prior
  to each use.

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Associate TB skin testing (PPD)

• Each Associate is responsible to have a T.B. skin
  test (PPD) done on time. Failure to do so will
  result in an unsuccessful and/or delayed
  performance appraisal. You will not be allowed
  to work if your TB skin testing is past due.
• Health and Wellness tracks all conversions (PPD
  previously negative that is now positive) by work
  site, enabling prompt detection of any problems.
  Conversion means EXPOSURE, not active disease.

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Exposure Follow-up

• When care is given to a patient who has TB, but
  is not diagnosed until later, every attempt is
  made to identify all exposed employees once a
  diagnosis of TB is made.
• Health and Wellness will administer a follow up
  TB skin test approximately 8-12 weeks after the
  last date of exposure.

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Patient Care Measures

• Patients must wear a surgical mask if they leave
  their room.
• They are no longer considered contagious when
• their cough subsides
• sputum smears are negative.
• This usually happens within 2 weeks after therapy
  begins.
• These patients should remain in isolation until
  the diagnosis of TB has been ruled out or until
  they begin responding to therapy.

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Airborne Isolation

• Place patients in isolation (Airborne) as soon as
  possible
• if they have signs and symptoms compatible with
  TB.
• if they are not receiving therapy, have just
  started therapy, or have a poor response to
  therapy.
• Air pressure in an isolation room is monitored by
  the Engineering Department.
• Should an audible or visual alarm occur in the
  patient's room, notify Engineering immediately!
  
• The pressure in the room must be less than the
  hallway outside to ensure air flows into but not
  out of the room.
• Keep the door to the room closed at all times.
  Enter and exit through the anteroom door.
• Air from an isolation room is exhausted to the
  outside of the hospital and is not
  re-circulated.
• Nursing must notify Engineering when a patient is
  placed in airborne precautions, and when the
  patient is removed from airborne precautions.

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Understanding TB -Definitions
Active - People with active TB disease are sick
from germs that are active in their body. They
have symptoms of TB, such as feeling sick,
coughing, weight loss, fever, or night sweats.
Usually, people with active TB disease of the
lungs or throat are capable of spreading the
disease to others. They are prescribed drugs that
can cure TB. AFB - Acid-fast bacilli. When
acid-fast bacilli are seen in sputum viewed under
a microscope, the patient should be assumed to
have active tuberculosis until proven otherwise.
At Risk - Certain groups are at risk (more
likely) to develop TB. These groups include the
elderly, the foreign-born, alcoholics, the
homeless, intravenous drug users, the
institutionalized, and people with chronic
diseases. INH - Isoniazid. An oral drug used by
itself to treat latent TB infection and in
combination with other anti-tuberculosis drugs to
treat active TB disease.
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Understanding TB -Definitions

• Isolation - Airborne isolation is used for TB.
  Infection control procedures should be followed
  when persons with known or suspected active TB
  are hospitalized. These precautions include use
  of a private room with negative air pressure and
  exhaust of air from the room directly to the
  outside of the hospital. Airborne Isolation is
  not the same as Respiratory Isolation or Droplet
  Isolation.
• IVDU - Intravenous drug user
• Latent - People with latent TB infection have the
  germ that causes TB in their bodies. They are not
  sick because the germs are inactive in their
  bodies. They cannot spread the germs to others
  however, these people may develop TB disease in
  the future. They are often prescribed treatment
  to prevent them from developing the disease.
• Mantoux A name for the TB skin test (sometimes
  also called a PPD).
• Medical Condition - Some medical conditions
  predispose people to become infected with active
  TB disease. These conditions include HIV, cancer,
  and diabetes.

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Understanding TB -Definitions

• PPD - Purified Protein Derivative. A positive
  PPD (or TB) skin test is a reaction to the
  material injected into the skin. This reaction
  suggests that the individual has been infected
  with the TB germ.
• Signs and Symptoms - Signs and symptoms of active
  TB disease include weight loss, fever, night
  sweats, coughing for more than three weeks, chest
  pain, coughing up blood, chills, difficulty
  breathing, shortness of breath, fatigue, an
  abnormal chest x-ray, and loss of appetite.
• Sputum - Material coughed up from deep within
  the lungs. Examination of the sputum by smear and
  culture is essential in determining what germ is
  causing the patient's infection. It should not be
  confused with saliva or nasal secretions.
• Tuberculosis - A communicable disease caused by a
  germ called Mycobacterium tuberculosis. It
  usually affects the lungs, but it may also
  affects other part of the body including the
  brain, kidneys, or spine. 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.

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Would you like to review?
Click on the statement below to see if it is True
or False.

• TB is spread from person to person through the
  air, for example, by coughing, singing, sneezing,
  and talking.
• Coughing for more than three weeks, fatigue, and
  an abnormal x-ray are symptoms of TB.
• A diagnosis of tuberculosis requires a physical
  exam, Mantoux tuberculin skin test, chest x-ray,
  and sputum smear and culture.
• Airborne isolation is used for known or suspected
  active TB.

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Educational Resources

• MWH and SHC Policies Procedures Databases
• Standard Precautions
• Definition of Terms for OSHA Exposure Control
  Plan
• MHS Corporate Policy Procedures Database
• Education, Information and Training for
  Bloodborne Pathogen (BBP) Standard
• Methods of Compliance to Limit Infections Among
  Personnel
• http//www.osha.gov/SLTC/healthcarefacilities/

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Exit Page
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• We hope this Computer Based Learning course has
  been informative and helpful.
• Please feel free to review the screens of this
  course until you are prepared to test your
  knowledge.

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Understanding TB - Review Answer
Return to Review Questions

• TRUE
• TB is spread from person to person through the
  air, for example, by coughing, singing, sneezing,
  and talking.

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Understanding TB - Review Answer
Return to Review Questions

• TRUE
• Coughing for more than three weeks, fatigue, and
  an abnormal x-ray are symptoms of TB.

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Understanding TB - Review Answer
Return to Review Questions

• TRUE
• A diagnosis of tuberculosis requires a physical
  exam, Mantoux tuberculin skin test, chest x-ray,
  and sputum smear and culture.

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Understanding TB - Review Answer
Return to Review Questions

• TRUE
• Airborne isolation is used for known or suspected
  active TB. Consider patients with suspected or
  confirmed active TB as infectious.
• These patients should remain in isolation until
  the diagnosis of TB has been ruled out or until
  they begin responding to therapy.