AIR

BORNE PATH

OGENS

INTRODUCTION TO HEALTHCARE

ALHS 1040

WHAT IS TUBERCULOSIS?

Tuberculosis is an airborne disease carried on

very small mucous droplets suspended in the air. It is released by an infected

person through….TalkingCoughingBreathingLaughingSinging

TUBERCULOSIS

• Caused by the bacteria: Mycobacterium Tuberculosis which can affect any site in the body, most often affecting the lungs.

• It can spread from person to person through the air.

Transmitted by respiratory droplets (droplet nuclei)…

Allows for rapid transmission Infects greater number of hosts in shorter amount of time.

At one time, was the leading cause of death in the U.S. at the beginning of the 20th century.

TUBERCULOSIS

TYPES OF EXPOSURE

Tuberculosis Infection Also calledLatent or Inactive TuberculosisTuberculosis Disease Also calledActive Tuberculosis

TUBERCULOSIS INFECTION

Can be present if…You have the TB organism in your bodyYou do not look or feel illYou test positive on a TB Skin TestCan be treated with…One drug therapyThe drug therapy usually last 6 months, but may last as long as one year.

TUBERCULOSIS INFECTION

If untreated…5% of those infected, develop TB disease within two years.

Another 5% will develop TB disease later in life.

TUBERCULOSIS DISEASE

You show signs of illness such as:Weight lossLoss of energyPoor appetite

May develop if you do not receive treatment for infection

You must receive more than one drug therapyDrug therapy usually last six months to one year.An individual is considered non infectious after 1-3 weeks of drug therapy, if symptoms improve.

TB INFECTION VS. TB DISEASE

ACCORDING TO THE CDC…

Tuberculosis Facts…There are 2-3 Million deaths worldwide associated with TB.

More than 1/3 of the world’s population has TB, totaling apx. 1 Billion Individuals

TUBERCULOSIS IN THE U.S.

• There are an estimated 10-15 million Americans infected with TB

• About 10% of those individuals will develop TB sometime in their life.

• In 1953, the US begins National Tuberculosis reporting. The World Health Organization announces that TB Disease and TB Infection will be eliminated by the year 2010.

• Between 1953-1985 the infection rate for TB is 6%

• In 1991 the CDC reports an 18% increase since 1985 in the number of people in the US with TB Disease.

TUBERCULOSIS IN THE U.S.

REASONS WHY TUBERCULOSIS HAS RE-EMERGED…

• Inadequate control of the disease in high prevalence areas.

• Increase in poverty, substance abuse, poor health status, crowded substandard living conditions.

• Growing number of inmates• Growing number of people in

homeless shelters.

RE-EMERGENCE OF TUBERCULOSIS

• Growing number of immigrants from foreign countries with high prevalence rates

• Growing number of elderly in long-term care facilities.

• Growing number of persons with HIV Infection

• Decreased funding for public health TB programs.

• Individuals with TB Infection are at a 100 time greater risk of developing TB Disease than the general population.

• Center for Disease Control and Prevention (CDC) estimate that 10% to 15% of all TB cases and nearly 30% of all TB individuals 25- 44 years of age are among those who are HIV infected.

TUBERCULOSIS IN THE U.S.

TUBERCULOSIS WORLDWIDE

• Someone in the world is newly infected with TB every second.

• Nearly 1% of the world’s population is newly infected with TB each year.

• Overall, 1/3 of the world’s population is infected with TB bacillus.

TUBERCULOSIS WORLDWIDE

• 5-10% of these people (if they are not HIV+) will become sick or infectious during their life.

• The chance is many times higher for someone with HIV/AIDS

• There are approximately 2 million TB related deaths yearly, worldwide.

TUBERCULOSIS WORLDWIDE

The World Health Organization estimates that the incidence rates of the TB epidemic peaked in 2005.

What do you think are the Top 10 causes of death worldwide…

POP QUIZ ANSWERS1. Coronary Artery Disease2. Strokes and other Cerebro-vascular

Diseases3. Lower Respiratory Infections4. Chronic Obstructive Pulmonary Disease5. Diarrheal Disease6. HIV/AIDS7. TUBERCULOSIS8. Lung Cancers9. Road Traffic Incidents10.Prematurity and low birth weight

WHAT DO WE NOT KNOW…

• How long the TB organism can remain suspended in the air.

• How long the TB organism can remain infectious outside the body.

• How many TB organisms are needed to cause infection in a person.

An estimated 15 Million people in the United States are infected with mycobacterium tuberculosis, leading to TB disease.

Increased number of TB disease cases causes greater risk of nosocomial transmission. Healthcare workers & others

have repeated, prolonged contact with these persons.

Multiple Drug Resistant strains. Antibiotics

TUBERCULOSIS FACTS

TUBERCULOSIS FACTS

o Primary infection can remain undetected and the individual may not develop any symptoms of TB.

o Usually within 2-10 weeks, an infection can be detected by the TB

skin test.o Those with significant skin test reaction but NO symptoms

are considered to have TB infection.oThey can NOT spread TB, BUT are at risk of developing ACTIVE TB.

oIf not treated, the mycobacteria may overcome the immune system and multiply in the future and cause development of the TB disease.

Diabetes Mellitus Silicosis Chronic Renal

Disease Prolonged

Steroid Therapy Post-Gastrectomy Intestinal Bypass Some Blood

Disorders

Chronic Malabsorption Syndromes

HIV Others with

depressed immune systems

* Early diagnoses is critical because of a greater risk of transmission.

THOSE WITH INCREASED RISK FACTORS FOR TUBERCULOSIS…

TUBERCULOSIS SIGNS & SYMPTOMS

o Persistent cougho Fevero Malaiseo Night Sweatso Fatigueo Loss of Appetiteo Weight Losso Chest Paino Hemoptysis

DIAGNOSIS & TREATMENTS

TB is suspected in patients with depressed immune systems.

Appropriate precautions should be taken.Appropriate treatment plan followed.Only proof is with positive sputum culture

Prompt treatment with Anti TB drugs quickly reduce infectiousness of patientTreatment with drugs usually lasting between 6-12 months.

If an individual has the TB disease, they will take several medicines to start their treatment, killing the TB germs in the body. They most common types of TB Diseases are:

1. Isoniazid (i-so-ni-a-zid) “INH”

2. Rifampin (ri-fam-pin)3. Ethambutol (eth-am-

byoo-tol)4. Pyrazinamide (peer-a-

zin-a-mide)

TREATMENT FOR TB DISEASE

TUBERCULOSIS TREATMENT

o Anti TB Drug (6-12 months)o HIV + persons are treated with 3-4

drug regiment.o Observe patient for non-compliance

which is a major problem.o With adequate treatment bacteria

will die and patient will recover.oEmergence of drug resistant strains of

TB-due to failure to comply with treatment modality.

TUBERCULOSIS TREATMENT TIPS

o If you stop taking medicines for TB disease early or do not take them the right away:

o You can become sick again and stay stick for a longer time.

o The medicines can stop working and you may have to take different medicines that have more side effects.

o Even the new medicines may not work to cure the TB.

o You can pass TB germs on to others again.

TUBERCULOSIS TREATMENT QUESTION

Q: Once I complete treatment for TB disease and I’m cured, can I get TB again ?

A: Yes, but it is not likely. After you take the medicine the right way for as long as your doctor tells you, your chance of getting TB again is low.

Call your doctor right away if you notice any of the signs of symptoms of TB again.

FACTORS THAT INFLUENCE TRANSMISSION OF TB

Degree of risk for health care workers depends on…

Healthcare settingPopulation served Job categoryHealth care worker’s immune system

Remember, the longer you share the same air without protection, the higher the risk of infection.

FACTORS THAT INFLUENCE TRANSMISSION OF TB

For healthcare providers, the risk of transmission includes:

The possibility of coming into contact with someone with TB based on….

The closeness of the contact The #of TB bacteria that are released in the air.

Duration of contact Susceptibility of the healthcare worker who was exposed.

FACTORS THAT INFLUENCE TRANSMISSION OF TBEnvironmental considerations also

influence transmission:o Volume of shared air spaceo Amount of ventilationo Presence or absence of sunlight which kills TB

bacteria.o Humidity in roomo Crowded condition within the room.

PRECAUTIONS FOR TUBERCULOSIS

1. Patient Identified/diagnosed

2. Placed in isolation, with doors closed at all times.

Rooms should be negative air pressured rooms- air is exhausted to outside, away from intake valves and not re-circulated.

Persons entering room should wear appropriate protective gear and masks.

TB PRECAUTIONS

o Patient should be fitted with the appropriate mask, gown, and other protective gear as needed when taken to other areas of the hospital

o Ventilation patterns in treatment rooms, ICU, labs, autopsy rooms & ER should meet current guidelines.

o Air controls systems Negative Air Pressure Rooms, HEPA Filters, HEPA ="High-Efficiency Particulate Air"

o Air flows INTO the room from the corridor

o Air inside the room is changed with a recommendation of 12 x /hour.

o Air is exhausted directly to the outside through HEPA filters, making the exhausted air harmless to the outside,

o If not exhausted to outside, air must be forced through particulate filters.

o Door should always stay closed and room identified as AFB isolation room.

WHAT IS NEGATIVE AIR PRESSURE ROOM?

CDC RECOMMENDATIONS

Disposable equipment available Proper disinfection/ sterilization of

used equipment Proper protective gear for health care

workers involved with patient Proper bagging technique & disposal

patients waste, lines, biohazard materials, and used equipment & gear.

Strict airborne isolation precautions sused.

TB SKIN TESTING

Health Care Personnel-Active Surveillance. Receive test at time employment

Testing consist of a standard dose of TB protein derivate beneath skin, producing elevation. Examine arm in 48-72 hrs for palpable swelling around injection site.

Interpretation of skin test is based on size of bump (induration) & not redness of the area Look for bump the size of a pencil eraser or larger-

this could mean you have the TB infection. Negative test should be repeated periodically

After exposure and at intervals thereafter.

TB TESTING

Positive skin test occurring after history of negative reaction should be considered newly infected with TB bacteria (It does NOT mean that the person has TB disease).

Chest x-ray & preventative therapy are necessary.No work restriction on person with positive skin test & negative chest x-ray.

DO NOT RETEST A POSITIVE SKIN TEST.THIS PERSON WILL ALWAYS NEED A CHEST X-RAY

OCCUPATIONAL EXPOSURE TO TUBERCULOSISWhat happens when an employee is

exposed to TB at work?Tuberculosis exposure incident report.Skin TestingMedical EvaluationIndicated TreatmentsSpecial rules for employees/medical rules

MORE ABOUT TB SKIN TESTING

All healthcare providers should be tested.

The recommended test is the Monteux PPD Skin Test

PPD=Purified Protein Derivative (Dead TB Bacteria) Identifies infected persons Performed by injecting PPD into skinExamined in 48-72 hoursResults are determined by size of the hard area under skin (induration)---NOT by redness