MANAGING TB IN INPATIENT SETTINGS

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1 MANAGING TB IN INPATIENT SETTINGS Kamera R. Riggins, BSN RN Infection Preventionist Infection Prevention and Control Wishard Health Services Indianapolis, IN OBJECTIVES Describe Wishard Health Services Infection Prevention and Control TB and Respiratory Protection Plan. Explain Wishard Health Services administrative process, engineering controls, education and training. Discuss the role of IPC in surveillance, DOT, and discharge planning process for Wishard Health Service patients. Discuss future goals for IPC at Wishard Health Services WISHARD HEALTH SERVICES An effective infection control program is provided in order to conduct safe, high quality healthcare services. The function of the infection control program is to identify risks for the transmission of infectious diseases among patients, staff, physicians, other licensed independent practitioners, contract service workers, volunteers, students, and visitors, and to facilitate the implementation of infection control practices that reduce the risk of disease transmission in the performance of healthcare related activities. Wishard Health Services. Infection Control Manual,

2 Wishard Health Services MYCOBACTERIUM TUBERCULOSIS AND RESPIRATORY PROTECTION PLAN The practices and procedures in the TB and respiratory exposure control plan are applicable to all individuals with potential contact to patients with infectious TB including staff, faculty, house staff, fellows, dentists, students, volunteers, contract persons, family, and visitors. Wishard Health Services. Mycobacterium Tuberculosis and Respiratory Protection Plan, Hospital Infection Prevention and Control It is the policy of Wishard Health Services to provide care to patients with Mycobacterium tuberculosis in a manner that minimizes the risk of transmission to others. Wishard Health Services. Mycobacterium Tuberculosis and Respiratory Protection Plan, Hospital Infection Prevention and Control Eff ti f d i i t ti k Effective use of administrative work processes Engineering controls Comprehensive healthcare worker surveillance program Appropriate use of respiratory protection 2

3 Administrative Process Providing direction and support of policies Occupational Health Clinic at WHS Facilities engineering Education and training Monitoring staff compliance Environmental Health and Safety Hospital Administration Risk Assessment Comprehensive TB policy Engineering Controls Special ventilation rooms/devices Monitoring of airflow and velocity in rooms are assessed, documentedand reported onby Facilities Engineering. Personal respiratory protection All new employees are fit tested on employment and annually on their anniversary date. Education and Training Hospital staff and volunteers Training content includes: P h i t Persons who wear respirators Extent, and specific hazards of TB transmission Specific risk for TB infection Signs and symptoms IPC policies Importance of wearing the respirator properly 3

4 Surveillance The early detection and treatment of active communicable TB is an important part of WHS TB exposure control plan. ED staff offer patients a mask when they present with active cough or signs/symptoms. This is typically done by the triage nurse or by the care tech who greets patients in front triage. Suspects are placed in negative airflow rooms. IPC is notified of all positive AFB smears by WHS microbiology lab. Isolation room reports are monitored by IPC. Sputum collection for TB suspects are done once daily for 3 consecutive days. Patients are kept in airborne isolation until no longer consider infectious and a risk to public safety. Directly Observed Therapy (DOT) WHS policy, in patients should be administered anti tuberculosis drugs by DOT. Marion County Health Department (MCHD) Public Health Nurses make in patient visits to complete health assessment and provide patient education about TB. Discharge Planning Physicians and case managers work with the Marion County Public Health Nurse to arrange DOT prior to patients discharge. Housing and transportation issues are addressed and resolved. Marion County Health Department Medication Service Referral Forms are completed and faxed to MCHD prior to discharge for all TB cases/suspects. IPC becomes involved with any isolation issues, such as when it s appropriate to release a patient from isolation or sputum collection questions. 4

5 Case Study In February , a 31 yr. old with a history of HIV, schizophrenia and bipolar disorder walked into the ED with a two week history of: cough productive of green sputum fevers night sweats worsening SOB left sided substernal chest pain headache dizziness w/o syncope watery diarrhea for about 2 days weakness and fatigue denied n/v, chills, hemoptysis Case Study (Cont.) X ray left upper lobe infiltrate on 2/9/10. Chest CT showed a left upper lobe cavitary lesion 2/9/10. On 2/10/10 IPC received a phone call from the AFB lab that the patient had a + AFB. Patient reported a history of a positive tuberculin skin test from August 2009, and +tuberculin skin test from jail. On 2/2/10 patient was seen in the Emergency Department, with similar signs/symptoms; chest x ray showed patchy left upper lobe infiltrate. He was diagnosed with bronchitis and sent home with doxycycline. IPC Key Responsibilities Collect all patient information and report Demographics, x ray, CT reports, Lab reports Complete TB case/suspect reporting form Fax to the county of residence. Enter into IPC reportable disease database. Look at admission dates, times, room pt. was in during ED admission 5

6 IPC Key Responsibilities con t Notify OHC, ED management of patient with +AFB. Investigation is started, did patient have a mask? Information is sent in house to the ED managers. Time patient was placed into negative air flow room? Was there any exposure to staff? Work with OHC, ED management to identify staff. IPC Key Responsibilities con t OHC maintains tuberculin skin test records, and sent out follow up notices. On 2/19/10, patient was not found in his room. IPC notified Marion County Health Department (MCHD). Indianapolis Metropolitan Police Department (IMPD) was notified. Future projects for IPC Completing an annual clinical education TB module for nursing staff. Develop with OHC and ED management to develop TB education for ED staff. Documentation for TB cases/suspects. 6

7 References Centers for Disease Control and Prevention. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health care settings, MMWR 2005; 54 (No. RR 17): Maj_guide/infectioncontrol.htm Errata (August 2006) available online Errata_table.pdf Wishard Health Services. Infection Control Manual, Wishard Health Services. Mycobacterium Tuberculosis and Respiratory Control Policy,

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