Blood borne pathogens seminar

Blood borne infections and tuberculosis: management of occupational exposure and

isolation precautions

Valerie Fletcher, M.D.

Blood borne pathogens

Microorganisms that are present in human blood and can cause disease in humans.

Pathogens include, but are not limited to, hepatitis B virus (HBV) and hepatitis C virus (HCV) and human immunodeficiency virus (HIV).

HBV, HCV and HIV may cause major occupational blood borne infections that are potentially fatal.

The risk of infection after exposure depends on several factors including:

- the pathogen involved- the type of exposure- the amount of blood or infectious material involved

in the exposure- and the amount of virus in the infectious material at the time of exposure.

Risk of acquiring infection after percutaneous injury with a contaminated hollow-bore needle are HBV > HCV > HIV.

Most exposures to infectious material do not lead to infections.

Most occupational exposures occur among health care workers (HCWs).

> 8 million US HCWs may be exposed to blood or infectious body fluids.

~ 800,000 percutaneous injuries occur per year in hospitals and other healthcare facilities.

44 percutaneous injuries reported at SOMC in 2004, 38 in 2005.

Body Fluid Exposure Type – SOMC, 2004 - 2005

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5

10

15

20

25

30

35

Needlestick Splash Cut Bite Other

2004 2005

Body fluid exposures – SOMC, 2004 - 2005

0

2

4

6

8

10

12

14

Surg ER ICU MCU 3N 1W Mat Lab HK Resp Sec

2004 2005

Percutaneous injuries – SOMC, 2004 - 2005

0

2

4

6

8

10

12

14

ER Sur MCU ICU 3N Mat Lab

2004 2005

Distribution of 10,378 reported percutaneous injuries among hospital workers by medical device associated with injury

1995 – 2000 (CDC)

Distribution of 6,212 reported percutaneous injuries involving hollow-bore needles in hospital workers by associated medical procedure 1995 – 2000 (CDC)

Isolation Precautions

Standard precautions – precautions designed to prevent transmission of HIV, HBV, HCV and other blood borne pathogens when providing first aid or healthcare.

Blood and certain body fluids of ALL patients are considered potentially infectious.

Standard precautions involve the use of protective barriers such as gloves, gowns, masks or protective eyewear which can reduce the risk of exposure of the skin or mucous membranes of HCWs to potentially infectious materials.

Precautions to prevent injuries caused by needles, scalpels and other sharp instruments also included.

Potentially infectious materials

blood

semen

vaginal secretions

cerebrospinal fluid

synovial fluid

pleural fluid

peritoneal fluid

amniotic fluid

saliva (if contaminated with blood)

any body fluid that is visibly contaminated with blood

Standard precautions(MMWR August 21,1987)

HCWs should routinely use appropriate barrier precautions to prevent skin and mucous membrane exposure when contact with blood or body fluid of any patients is anticipated.

Hands and other skin surfaces should be washed immediately and thoroughly if contaminated with blood or other body fluids. Hands should be washed immediately after gloves are removed.

HCWs should take precautions to prevent injuries caused by needles, scalpels and other sharp instruments or devices during procedures; when cleaning used instruments, during disposal of used needles and when handling sharp instruments after procedures.

Mouthpieces, resuscitation bags, or other ventilation devices should be available for use in areas in which the need for resuscitation is predictable.

HCWs who have exudative lesions or weeping dermatitis should refrain from all direct patient care and from handling patient care equipment.

Pregnant HCWs are not known to be at greater risk of contracting HIV infection than HCWs who are not pregnant; however if a HCW develops HIV during pregnancy, the infant is at risk of infection resulting from perinatal transmission. Pregnant HCWs should therefore be especially familiar with and strictly adhere to precautions to minimize the risk of HIV transmission.

Engineering and Work Practice Controls

Standard precautions are used at all times in caring for all patients.

Handwashing facilities (or alcohol-based hand rub) are readily accessible to all employees.

Eating, drinking, smoking, applying cosmetics and handling contact lenses are prohibited in areas where there is a reasonable likelihood of occupational exposure.

Food and drink should not be kept in refrigerators, freezers, shelves, cabinets or on countertops where blood and body fluids may be present.

Mouth pipetting/suctioning of blood or other potentially infectious materials is prohibited.

Specimens of blood or other potentially infectious materials should be placed in a container which prevents leakage during collection, handling, processing, storage, transport or shipping.

Personal protective equipment, appropriate to the situation, should be used in all situations in which there is a reasonable likelihood of occupational exposure.

A 1:1 dilution of bleach (sodium hypochlorite) is an appropriate disinfecting agent.

Broken glass is never picked up with hands, even if wearing gloves. Use an appropriate sweeping device and pan to collect pieces of glass.

Hand hygiene

HANDWASHING IS THE SINGLE MOST IMPORTANT MEANS OFHANDWASHING IS THE SINGLE MOST IMPORTANT MEANS OF

PREVENTING THE TRANSMISSION OF INFECTION.PREVENTING THE TRANSMISSION OF INFECTION.

Hands are wet with running water.

Lather with soap for at least 15 seconds.

Rinse hand with running water.

Dry hands with disposable towel.

Turn off tap with disposable paper towel.

Place disposable towel in appropriate container.

Handwashing

Waterless alcohol-based hand rub or rinse

Approx. 3 ml of product taken from dispenser and rubbed on dry skin for about 30 sec until alcohol evaporates.

Effective only on areas in contact with rub or rinse.

Does not remove soil or organic material.

Contains 60 -70% alcohol.

Contains a moisturizer to prevent drying of skin.

Waterless alcohol-based rubs are recommended for areas in which sinks for hand washing are not readily available.

Alcohol-based rubs have been shown to be superior to plain soap for hand washing because of the antimicrobial effect.

Alcohol-based rub does not replace hand washing for visibly soiled hands.

Personal protective equipment (PPE)

Specialized clothing or equipment worn by employee for protection against contamination with blood or body fluids which may transmit infectious agents.

General work clothes not intended to function as ‘protective clothing’ are not considered to be PPE.

PPE can fail. Standard precautions and careful attention while performing all patient care duties will minimize the risk of personal contamination.

PPE is considered appropriate if it does not allow blood or other potentially infectious material to pass through it and reach the employee’s clothing, undergarments, skin and mucous membranes under normal condition of use and for the duration of time for which the protective equipment is to be used.

PPE sufficient to provide an appropriate protective barrier should be readily available to all employees. The use of PPE is required in all situations in which there is a reasonable possibility of contamination with blood or other potentially infectious material.

PPE are gloves, masks, isolation gowns, laboratory coats, aprons, face shields, goggles, ventilation devices, shoe covers, hats and hoods.

Gloves

Should be worn when it can be reasonably anticipated that an employee may have hand contact with blood, other potentially infectious materials, mucous membranes and non-intact skin, when performing vascular access procedures and when handling or touching contaminated items or surfaces.

Disposable (single use) gloves should be used for all patient care functions and procedures. Hand are washed before putting on gloves and immediately following removal of the gloves.

Gloves must be changed and hands washed between patients.

Following use of gloves, they should be disposed of in an appropriate biohazard container. Used gloves are to be considered contaminated.

Disposable gloves are not to be washed or in any way cleaned for reuse.

Utility gloves are preferable for housekeeping tasks. Utility gloves may be decontaminated for reuse. They should be discarded if cracked, peeling, torn, punctured, or show signs of deterioration or excessive wear.

If, during a procedure or task, a glove is punctured, torn or its ability to function as a barrier is in any way compromised, the glove should be removed as soon as feasible. Hands are then washed and inspected for possible puncture or damage to the skin, and a new glove is put on. Punctures or skin breaks should be reported.

Gloves are used for touching blood and body fluids requiring universal precautions, mucous membranes, or non-intact skin of all patients.

for handling items and surfaces soiled with blood or body fluids to which universal precautions apply.

for performing phlebotomy when HCW has cuts, scratches, or other breaks in his/her skin, or if hand contamination with blood may occur; when receiving training in phlebotomy.

when performing finger and/or heel sticks on infants or children.

Masks, Eye Protection, Face Shields

Masks in combination with eye protection devices (goggles, glasses with solid side shields, or chin-length face shields) should be worn whenever splashes, spray, splatter or droplets of blood or other potentially infectious materials may be generated and eye, nose or mouth contamination can be reasonably anticipated.

Glasses are preferable to contact lenses for heath care workers who have potential exposure to blood borne pathogens.

Masks and eye protection are not necessary for those tasks in which aerosols are not likely to occur such as venipuncture and suture removal.

Mask and eye protection should be used for dental procedures in which aerosols may be created.

Surgical masks

Protective eyewear

Gowns, Aprons, and Protective Body Clothing

Appropriate protective clothing such as, but not limited to, gowns, lab coats, aprons, clinic jackets or similar outer clothing should be worn when it is reasonably anticipated that contamination with blood or other infectious materials may occur. The type of garments will depend on the task and the degree of exposure anticipated.

In general, extreme barrier precautions (surgical caps, shoe covers, and hoods) are necessary in instances in which gross contamination is reasonably anticipated.

In are office setting, impervious disposable gowns are, in general, adequate.

Housekeeping

If a surface becomes contaminated, clean IMMEDIATELY.

Use Standard Precautions including appropriate barriers.

Clean gross contamination with disposable towel or larger implement.

Wash contaminated area with detergent and hot water.

Disinfect surface by spraying or flooding with approved disinfectant.

Dry area with disposable towel.

At the end of the work day, all surfaces that may have been contaminated should be cleaned and disinfected.

Protective covers should be replaced as soon as feasible after contamination.

Contaminated covers and disposable cleaning agents should be disposed of in suitable containers for contaminated wastes.

All bins and other receptacles for reuse that have a reasonable likelihood of being contaminated should be inspected and decontaminated on a regular basis.

Dental Operatories

Dental operatories should be cleaned between patients, and disposable items discarded.

Surfaces should be cleaned and disinfected.

Soiled dressings, packing material, removed sutures, dental wires and appliances, removed teeth and tissue should be considered contaminated, and disposed of appropriately.

Used reusable dental instruments should be cleaned and sterilized.

All needles and disposable sharps should be handled in accordance with Standard Precautions.

Disposal of sharps

Appropriate sharps containers must be available in all patient areas. They must have appropriate “BIOHAZARD” labeling.

All sharps are to be placed in these containers IMMEDIATELY following use.

If sharps container is punctured or leaks, it is to be placed in another impervious container which is labeled with the appropriate “BIOHAZARD” label.

SHARPS CONTAINERS SHOULD NOT BE ACCESSIBLE TO PATIENTS, ESPECIALLY CHILDREN.

Sharps containers should not be overfilled.

They must be kept in an upright position.

Full sharps container are never to shaken to settle the contents.

Transport of sealed sharps containers is to be done in accordance with polices regarding transport of infectious waste.

Needles are never to be cut, bent, broken, or reinserted by two-handed method (recapped) into their original sheaths.

Sharps container

Exposure to saliva

Practices to minimize exposure to saliva include use of gloves for digital examination of the mucous membranes and endotracheal suctioning.

Handwashing after exposure to saliva.

Minimizing the need for emergency mouth-to-mouth resuscitation by making mouthpieces and other ventilation devices available for use in areas where the need is predictable.

Ventilation masks

Pocket ventilation mask

Laundry

All laundry that is visibly contaminated, or that has a reasonable likelihood of being contaminated, should be considered contaminated.

Contaminated laundry should be handled as little as possible.

Standard precautions should be observed at all times when handling contaminated laundry.

Contaminated laundry should be placed in impervious containers or bags at the location in which it is used.

Contaminated laundry should not be sorted or rinsed in the location of use.

It should be placed and transported in bags or containers that are readily identifiable as containing contaminated items. These bags or containers must be able to prevent leakage of fluid.

BIOHAZARD labeling is not required if standard precautions are used when handling all soiled laundry, provided that all employees can readily recognize containers holding soiled laundry.

Appropriate PPE should be available to all employees who have contact with contaminated laundry.

Labeling of Potentially Hazardous Materials

All containers of regulated waste, refrigerators, and freezers containing blood and other potentially infectious material and other containers used to store, transport, or ship blood or other potentially infectious material should be clearly labeled with an international biohazard label symbol or placed in a red bag or red container which meets the requirements of the policies for handling trash or infectious waste.

Equipment which has been exposed to possible contamination by blood or other potentially biologically hazardous material should be labeled in an easily visible manner with a biohazard label specifically referencing the area of the equipment which is contaminated. Equipment so labeled should then be handled in accordance with the local housekeeping policy on potentially contaminated equipment.

All employees should practice Standard Precautions and comply with the specific requirements of the local policy for handling trash and infectious waste, when exposed to any biological waste or potentially biological contaminated equipment.

Management of Occupational Blood Exposure

Provide immediate care to the exposed site - wash wounds and skin with soap and water

- flush mucous membranes with water

Determine risk associated with exposure by - type of fluid (eg blood, visibly bloody fluid, other potentially infectious fluid or tissue, and concentrated virus)

- type of exposure (ie percutaneous injury, mucous membrane or nonintact skin exposure, and bites resulting in blood exposure)

Evaluate exposure source - Assess the risk of infection using available information

- Test the known sources for HBsAg, anti-HCV, and HIV antibody

- For unknown sources, assess risk of exposure to HBV, HCV or HIV infection

- Do not test discarded needles or syringes for virus contamination.

Evaluate the exposed person - Assess immune status for HBV infection (ie by history of hepatitis B vaccination or vaccine response)

EXPOSURE REPORT

Acute Viral Hepatitis A, B and C/NANB by Year, United States, 1952-2000

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5

10

15

20

25

30

35

40

45

1952 54 56 58

1960 62 64 66 68

1970 72 74 76 78

1980 82 84 86 88

1990 92 94 96 98

2000

Year

Rep

orte

d ca

ses

per

100,

000

popu

lati

on

Hepatitis A

Hepatitis C/ NANB

Hepatitis B

Total

Hepatitis B and C in Scioto County

0

10

20

30

40

50

60

70

80

Num

ber

of cases

2002 2003 2004 2005

Hep B Hep C

Hepatitis

Hepatitis B virus (HBV) and hepatitis C virus (HCV) may cause severe liver disease.

Symptoms of acute infection include nausea, vomiting, abdominal pain and jaundice.

HBV becomes chronic in ~ 20% of infected patients.

HCV becomes chronic in ~ 80% in infected patients.

Chronic infection may be asymptomatic

The risk of acquiring HBV infection from a single needle-stick contaminated with HBV-infected blood ranges from 6 – 30%.

Risk of transmission depends on the HBeAg status of the source; HBeAg-positive patients have more circulating viruses and are more infectious.

There is a risk of infection after exposure of mucous membranes or non-intact skin.

No known risk of infection from exposure to intact skin.

Hepatitis B

Estimated number of occupational hepatitis B infections among US health care workers, 1983 – 1999 (CDC)

Recommended PEP for exposure to HBV

TreatmentVaccination and antibody response status of exposed workers

Source HBsAg positive

Source HBsAg negative

Source unknown or unavailable for testing

Unvaccinated HBIG x 1 and initiate HB vaccine series

Initiate HB vaccine series

Initiate HB vaccine series

Previously vaccinated

- known responder

-known non-responder

No treatment

HBIG x 1 and initiate revaccination

or HBIG x 2

No treatment

No treatment

No treatment

If known high risk source, treat as if source HBsAg positiive

Antibody response unknown

Test exposed person. No treatment if HBsAb positive.

If inadequate antibody titer, administer HBIG x1 and vaccine booster

No treatment Test exposed person for HBsAb. No treatment if HBsAb positive.

If inadequate antibody titer, administer vaccine booster and re-check titer in 1 – 2 month

Perform follow-up anti-HBs testing in persons who receive hepatitis vaccine.

Test for anti-HBs 1 – 2 months after last dose of vaccine.

Anti-HBs response to vaccine cannot be ascertained if HBIG was received in the previous 3 – 4 months.

Hepatitis C

The risk of HCV infection after needle-stick exposure to HCV-infected blood ranges from 1-3%.

Transmission may occur after exposure of mucous membrane or non-intact skin.

No known risk from exposure to intact skin.

No estimates of the number of HCWs occupationally infected with HCV.

~1% of HCWs are infected with HCV, and ~3% US population have evidence of infection.

Perform baseline and follow-up testing for anti-HCV and alanine aminotransferase (ALT) 4 – 6 months after exposure.

Perform HCV RNA at 4 – 6 weeks if earlier diagnosis of HCV infection desired.

Confirm repeatedly reactive anti-HCV results with supplemental tests.

Post-exposure prophylaxis (PEP) not recommended.

Human Immunodeficiency Virus

HIV infects different cells (eg lymphocytes) in the body and weakens the immune system.

Infection may be asymptomatic for several years.

~ 1 million persons in USA infected with HIV.

~ 500,000 people in USA have died as a result of HIV disease.

Symptomatic HIV infection (HIV disease) occurs as the infected CD4 lymphocytes are depleted.

Manifestations of HIV disease include uncommon cancers and severe infections with typical and atypical pathogens.

Acquired immunodeficiency syndrome (AIDS) is defined as CD4 < 200, or occurrence of certain opportunistic infections or cancers.

Health care workers and occupational exposure to HIV

57 documented HIV infections among HCWs after occupational exposure up to December 2001.

138 possible cases of HIV infection among HCWs due to occupational exposure.

49 (86%) HCWs with occupational HIV exposed to blood.

88% had percutaneous injury.

8 patients acquired HIV after muco-cutaneous exposure.

55 known source patients (HIV seropositive).

38 (69%) source patients had AIDS.

6 (11%) source patients had asymptomatic HIV infection.

18 source patients were on antiretroviral therapy at the time of HCW exposure.

8 (14%) HCWs acquired HIV infection despite PEP.

3 infections occurred after 1996, when combined antiretroviral therapy was introduced. 2 exposed HCWs had no PEP and one was exposed to multi-drug resistant (MDR) HIV.

PEP does not always prevent infection.

Continue to emphasize avoidance of exposure.

Distribution and number of documented cases of occupational transmission of HIV among health care workers by occupation,

1981 – 2002 (CDC)

Determining the need for HIV PEP after occupational exposure (CDC)

STEP 1

Infectious source material

Yes No No PEP needed

What type of exposure has occurred

Mucous membrane or non-intact skin

Intact skin* Percutaneous exposure

No PEP needed

Volume Severity

STEP 2

What is the HIV status of the exposure source

HIV negative HIV positive Status unknown

Sourceunknown

No PEP needed

Lower titer exposure

Higher titer exposure

HIV Post-Exposure Prophylaxis

Basic regimen:

zidovudine (AZT) 300mg bid + lamivudine (3TC) 150mg bid

x 28 days

Expanded regimen:

Basic regimen + Kaletra (lopinavir/ritonovir) {or atazanavir (Reyataz)

or indinavir (Crixivan) or nelfinavir (Viracept)

or efavirenz (Sustiva)}

x 28 days

Initiate PEP as soon as possible, preferably within 2 hours of exposure.

Offer pregnancy testing to all women of childbearing age not known to be pregnant.

Seek expert consultation if viral resistance is suspected.

Administer PEP for 4 weeks if tolerated.

Perform HIV antibody testing for at least 6 months postexposure (baseline, 6 weeks, 3 months, and 6 months)

Perform HIV antibody testing if illness compatible with an acute antiretroviral syndrome occurs.

Advise exposed persons to use precautions to prevent secondary transmission during the follow-up period.

Evaluate exposed persons taking PEP within 72 hours after exposure and monitor for drug toxicity for at least 2 weeks.

Confidentiality and legal issues

HIV tests are done after verbal or written consent.

HIV tests may be done on source patients in Ohio without consent.

Person being tested may be identified by name or a code.

Patients to be tested are counseled before testing.

Testing and test results are confidential.

Tuberculosis

Mycobacterium tuberculosis is spread by airborne particles which can be generated when a person with pulmonary or laryngeal TB coughs, sneezes, shouts or sings.

The particles are 1 – 5 µm and can be kept airborne for prolonged periods by normal air currents.

Particles may be spread around a room or building unless contained.

Infection occurs when a person without immunity to TB inhales airborne droplets containing M. tuberculosis.

Typical primary infection in adults is clinically and radiologically silent (latent).

Latent tuberculosis infection (LTBI) is contained. Viable bacteria may lie dormant in granulomata for years without reactivation.

Persons with LTBI do not have active tuberculosis and do not transmit the infection to others.

Immunocompetent patients with LTBI have a positive tuberculin test.

Active pulmonary tuberculosis may present with slowly progressive constitutional symptoms of malaise, anorexia, weight loss, fever and night sweats.

Respiratory symptoms include chronic cough with production of sputum which may be blood-tinged.

Difficulty in breathing may be experienced in extensive disease.

Persons with active infection may be asymptomatic.

Extra-pulmonary tuberculosis may involve lymph nodes, GI tract, kidneys and brain.

Tuberculosis in Scioto County

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40

2001 2002 2003 2004 2005

Year

Num

ber

Active Cases Number of patients on preventative therapy

CXR – infiltrates, cavities, lymph nodes, pleural effusion, calcified granulomata.

Lab diagnosis – mycobacterial (AFB) smear and culture, susceptibility testing, M. tuberculosis PCR.

M. tuberculosis grows slowly (6 -8 weeks in the lab)

HIV and TB

More susceptible to infection at any CD4 lymphocyte count.

Patients with HIV are more likely to progress to active disease after infection.

Extra-pulmonary TB more common.

• Tuberculin skin test may not be reliable (anergy). Tuberculin skin test may not be reliable (anergy).

• Positive TST is ≥ 5mm.Positive TST is ≥ 5mm.

• CXR atypical in severely immunosuppressed.CXR atypical in severely immunosuppressed.

• Duration of treatment may exceed 6 months.Duration of treatment may exceed 6 months.

Multi-drug resistant tuberculosis

TB that is resistant to the first-line antibiotics of isoniazid, rifampin, ethambutol and pyrazinamide.

Resistance occurs if TB is incompletely treated eg non-adherence to usual antibiotic regimen.

More commonly seen in patients with HIV.

Associated with increased mortality because of delay in appropriate therapy and paucity of effective antibiotics.

Treatment includes use of intravenous and intramuscular antibiotics and may exceed 12 months.

The tuberculin skin test (TST) (PPD) becomes positive 2 – 12 weeks after infection.

M. tuberculosis infection becomes latent in most cases (LTBI) (mycobacteria are present in the body but produce no symptoms).

Persons with LTBI are not infectious.

Some persons who are infected will develop TB disease (active infection) and may be infectious.

Tuberculin skin test

Tuberculin Skin Test (TST)

Changes in Guidelines for Prevention of Transmission of Mycobacterium Tuberculosis in Health-Care settings

The term “Tuberculin skin test” (TST) used instead of purified protein derivative (PPD).

Whole-blood interferon gamma release assay (QuantiFERON®-TB Gold test [QFT-G]) is FDA-approved for testing cell-mediated immune reactivity to MTB, and may be used instead of TST in TB screening programs for HCWs.

Frequency of TB screening for HCWs has been decreased in various settings, and the criteria for determination of screening frequency has been changed.

The scope of settings in which the guidelines apply has been broadened to include laboratories and additional outpatient and non-traditional facility settings.

These recommendations usually apply to an entire healthcare setting rather than areas within a setting.

New terms, airborne infection precautions and airborne infection isolation room, are introduced.

Recommendations for annual respirator training, initial respirator fit testing, and periodic respirator fit testing have been added.

Information on ultraviolet germicidal irradiation and room-air recirculation units has been expanded.

Additional information regarding MDR TB and HIV infection have been included.

Quantiferon Gold – Blood Assay for M. tuberculosis (BAMT)

Whole blood assay to measure the body’s response to 2 MTB proteins.

Single blood draw.

No need for a 2 step test.

Not subject to reader bias.

Not affected by prior BCG.

Aids in the diagnosis of MTB infection

Characteristics of a patient with TB disease that increase the risk for infectiousness

Presence of a cough Cavitation on CXR Positive acid-fast bacilli (AFB) sputum smear results. Respiratory tract disease with involvement of the larynx. Respiratory tract disease with involvement of the lung or

pleura. Failure to cover the mouth and nose when coughing. Incorrect, lack of, or short duration of anti-tuberculosis

treatment. Undergoing cough-inducing or aerosol-generating procedures.

Environmental factors that increase the risk for probability of transmission of M. tuberculosis

Exposure to TB in small, enclosed spaces.

Inadequate local or general ventilation that results in insufficient dilution or removal of infectious droplet nuclei.

Recirculation of air containing infectious droplet nuclei.

Inadequate cleaning and disinfection of medical equipment.

Improper procedures for handling specimens.

Other factors contributing to transmission of M. tuberculosis in health care setting

Delayed diagnosis of TB disease.

Delayed initiation and inadequate airborne precautions.

Lapses in airborne infection isolation practices and precautions for cough-inducing and aerosol-generating procedures.

Lack of adequate respiratory protection.

Prevention of Transmission of Tuberculosis

Risk of transmission of TB in health care facilities from patients with unrecognized TB.

Patients with signs and symptoms of active infection should be isolated from general population.

Patient who is admitted is managed in airborne isolation until non-infectious.

Patient wears surgical mask if leaving the room for special procedures.

N95 mask worn by HCWs and visitors entering the room.

N95 respirator

Management of tuberculosis in an office setting

Schedule as first or last appointments for the day.

Take patient to exam room as quickly as possible.

Keep patient in exam room until all procedures completed

Seat patient in least crowded area of waiting room.

Enforce cough hygiene; dispose of contaminated tissues in appropriate containers.

Clean room after patient has left; MTB on environmental surfaces rarely associated with transmission of TB.

Take care not to alarm other patients.

Responsibilities of Employer

Hepatitis B vaccine Provide appropriate personal protective equipment Readily available safety policies and procedures Educate staff as appropriate for job description Provide “safe” sharps as appropriate Provide PEP as appropriate Document all employee blood and body fluid exposure Maintain documentation of employee education

Responsibilities of Employee

Understand and follow all safety policies and procedures Use safety equipment properly and appropriately Participate in appropriate in-services and educational programs Document education Report ALL exposures to blood and body fluid in a timely

manner Maintain good personal hygiene and updated immunizations;

report illnesses as appropriate