Author: Maxine Edwards, RN, ICP ECU Infection Control

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

2. TuberculosisAirborne Pathogen Old Enemy New Battle

5. TB Trends by Case Rate Per 100,000 Population

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

7. MTB Cases in NC

8. TB Cases by NC County 2007 Number 18-54 8-17 3-7 0-2

9. 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%)

10. Transmission • 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

11. Signs & Symptoms • 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

13. How do we test for TB? • 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.

16. How do Healthcare Workers avoid exposure to 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.

19. N-95 Respirator • 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

20. 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

21. Power Air-Purifying Particulate Respirators (PAPR)

24. 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

25. What if I am diagnosed with 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)

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

27. 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