Tuberculosis

1. Tuberculosis Precautions & Prevention

2. Tuberculosis – What is it • Tuberculosis (TB) is caused by a bacterium called Mycobacterium tuberculosis that is inhaled into the alveoli of the lungs. • The bacteria usually attack the lungs, but TB bacteria can attack any part of the body such as the kidney, spine, and brain. • If not treated properly, TB disease can be fatal.

3. Statistics - How many cases of Tuberculosis (TB) were reported in the United States in 2011? • A total of 10,528 TB cases (a rate of 3.4 cases per 100,000 persons) were reported in the United States in 2011. • Both the number of TB cases reported and the case rate decreased; this represents a 5.8% and 6.4% decline, respectively, compared to 2010. The number of reported TB cases in 2011 was the lowest recorded since national reporting began in 1953.

4. Tuberculosis Cases and Case Rates per 100,000 Population: States AZ and CO, 2011 and 2010

5. Spread of TB • TB is spread through the air • Commonly spread when indoors with someone infected • TB is not spread by: • Linens • Toothbrushes • Sharing food or drink • Shaking someone’s hand • Kissing

6. Tuberculosis Latent TB Infection Active TB Disease Symptoms include Cough, Fever, Fatigue, Night Sweats, and weight loss. Can appear to be a cold, flu, or pneumonia. Cough lasting > 3 weeks Coughing up blood Positive culture or smear • Lives in the body but does not make you sick • No symptoms of TB • Not infectious • Cannot spread TB • Can lead to TB disease • Can prevent active TB with preventative drugs • Negative sputum smear

7. Active TB • When the immune system becomes weakened – Latent TB can become Active TB. • Weakened immune systems can occur from: • Stress • Poor nutrition • Substance abuse • Sickness • HIV (AIDS) • Night sweats

8. Drug – Resistant TB • TB organisms multiply at an alarming rate because people stop taking their medications too soon. • Strains that resist two or more drugs = Multi-Resistant TB • MDR – TB has a 50-80% mortality rate • Today it is estimated that 5.5% of new cases are MDR-TB • Mostly limited to large urban areas

9. Testing for TB • Commonly used to test for TB is the PPD skin test Area administered on the arm is checked in 48-72 hours • A hard raised red area means you likely have TB infection • If exposed or suspected TB – immediate PPD is indicated • If positive – further testing will be performed • Sputum culture • Chest X-ray

10. Administering a TB Skin Test • The Tuberculin skin test is performed by injecting 0.1 ml of tuberculin purified protein derivative (PPD) into the inner surface of the forearm. • The injection should be made with a tuberculin syringe, with the needle bevel facing upward. • The Tuberculin skin test is an intradermal injection. The injection should produce a pale elevation of the skin (a wheal) 6 to 10 mm in diameter.

11. How to Read a TB Skin Test • The skin test reaction should be read between 48 and 72 hours after administration. • If the skin test is not read within 72 hours, the person will need to be rescheduled for another skin test. • The reaction should be measured in millimeters of the induration (palpable, raised, hardened area or swelling). The reader should not measure erythema (redness). • An induration of 15 or more millimeters is considered positive in any person, including persons with no known risk factors for TB.

12. High Risk • Immunocompromised individuals • Individuals in depressed socio-economic areas • Foreign-born persons from countries with high rates of TB • Anyone living with someone who has active TB • Anyone who regularly comes in contact with these groups. • People who work with high risk groups, should be tested every six

13. TB Infection Control Program • Environmental Controls • Negative air pressure • Booths, hoods, tents • HEPA filtration • Properly fitted respirator masks

14. Work Safety – Respirator Masks • Wear an approved respirator • Be properly trained in the use of a respirator mask • Wear every time you enter the room of a TB isolated patient. • Transport a patient with known or suspected TB • Perform high-hazard procedures including:

15. TB Infection – Environmental Controls • Noncritical items are those that either do not touch the patient or touch only the patient’s intact skin. These items are not associated with direct transmission of M. tuberculosis, and washing them with detergent is usually sufficient. • Although microorganisms are ordinarily found on walls, floors, and other environmental surfaces, these surfaces are rarely associated with transmission of infections. • This is particularly true with organisms such as M. tuberculosis, which generally require inhalation by the host for infection to occur.

16. TB Infection Control Program • Administrative Controls • Developing and instituting a written control plan • Implementing practices for managing patients with TB • Ensuring proper decontamination of equipment • Educating, training, and counseling health-care workers about TB infection and disease. • Testing and evaluating workers who are at risk for exposure to TB disease

17. Tuberculosis Treatment • Medications are the cornerstone of TB treatment • ABT for six to nine months • Isoniazid, Rifampin, Ethambutol, Pyazinamide • After about four weeks – no longer contagious • Crucial to complete full course of therapy • Stopping medication to soon – lead to drug-resistance • More dangerous and difficult to treat

18. TB Prevention and Detection • Understand TB and how it spreads • Recognize the symptoms of TB • Take necessary precautions • Receive periodic testing • Receive proper treatment

19. References Center for Disease Control. TB Factsheets. 2011. http://www.cdc.gov/tb/publications/factsheets/statistics/TBTrends.htm [accessed 21 December 2012] Center for Disease Control. TB Factsheets. 2011. http://www.cdc.gov/tb/publications/factsheets/testing/skintesting.htm [accessed 31 December 2012.