SECTION 10.7 TUBERCULOSIS

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1 SECTION 10.7 TUBERCULOSIS Introduction Risk Groups Signs and Symptoms Mode of Transmission Incubation Period and Infectivity Notification of Infectious Diseases Infection Prevention and Control Measures Resident/Client Placement Personal Protective Equipment Resident/Client Care Equipment Environmental Hygiene Healthcare Workers Developed by Niamh Mc Donnell, Liz Forde, Patricia Coughlan and Maire Flynn In conjunction with Dr. Margaret O Sullivan Consultant in Public Health Medicine Date developed August 2012 Approved by Cork and Kerry Infection Prevention and Control Committee Kerry Infection Prevention and Control Committee Reference number IPCG 10.7 / 2012 Revision number 0 Revision date 2015 or sooner if new evidence becomes available Responsibility for Infection Prevention and Control Nurses review HSE South (Cork and Kerry) Page 1 of 5

2 Introduction (TB) is an infectious disease caused by Myobacterium tuberculosis complex, a group of bacteria of which Mycobacterium tuberculosis is the most common. The organism may infect any part of the body however the majority of cases involve the respiratory system. TB remains a significant cause of morbidity and mortality worldwide. TB used to be more common in Ireland; there were nearly 7,000 cases a year in the early 1950 s. In Ireland in 2009 there were 478 cases of TB notified. Multi drug resistant TB (MDR-TB) is a specific form of TB which is resistant to at least two of the main first line drugs used in the treatment of TB. MDR_TB is therefore much more difficult to treat. Extensively drug resistant TB (XDR_TB) which is also resistant to the first line and second line drugs used in the treatment of TB. With XDR_TB treatment options are more limited. Risk Groups TB maybe transmitted from a person with active TB disease especially active respiratory TB disease. Some individuals are more likely than others to develop TB infection when exposed. Close contacts of infectious TB cases e.g. household contacts are at most risk of exposure to the disease. The degree of infectivity of the case, the duration and proximity of contact with the case are important risk factors. The following people have a greater risk of becoming ill with TB if exposed to it; Children, The elderly, People with diabetes, People on steroid or other immunosuppressant therapy, People who are HIV positive, People dependent on drugs or alcohol, People with chronic poor health, People in over crowded or poor housing. Signs and Symptoms Symptoms of active TB can include the following; Fever and night sweats, Unexplained productive cough generally lasting more than 3 weeks, Weight loss, Blood in the sputum Chest pain, Weakness or fatigue. Mode of Transmission TB is usually spread in the air from another person who has respiratory TB and is coughing up infective sputum. It maybe spread by that person coughing, sneezing or spitting. However, close and generally prolonged contact over a period with such a person is needed to become infected. Most cases of infectious TB stop being infectious after a few weeks of appropriate treatment. TB in other parts of the body is usually not infectious. HSE South (Cork and Kerry) Page 2 of 5

3 Incubation Period and Infectivity The incubation period is usually 3-8 weeks this can occasionally can be as long as 12 weeks. The infectious period is for as long as there are viable micro-organisms in the sputum. With appropriate treatment most people are non-infectious within 2 weeks. Notification of Infectious Disease TB is a notifiable disease. A medical practitioner and a clinical director of a diagnostic laboratory on suspecting or identifying a case of TB are obliged to notify the Medical Officer of Health in the Department of Public Health. Once the Department of Public Health is notified of a case of TB, close contacts of the case are identified and screened for TB. Infection Prevention and Control Measures Resident/Client Placement Suspected or confirmed cases of TB cases in residential facilities should be placed in a single room using Standard and Airborne Precautions whilst infectious. The infectious period is for as long as there are viable micro-organisms in the sputum. With appropriate treatment most people are non-infectious within 2 weeks. The treating consultant will advise in specific cases. For detailed information on Standard Precautions refer to section 3 and Airborne Precautions refer to section 6 Transmission Based Precautions. Personal Protective Equipment (PPE) In addition to the PPE advised for Standard Precautions the following measures apply to residents/clients on Airborne Precautions whilst infectious. The treating consultant will advise when the patient is non-infectious.: Respiratory Masks and other face protection FFP2 masks are recommended for routine care of patients with known or suspected pulmonary or laryngeal TB where MDR-TB or XDR-TB is not suspected. FFP3 masks are recommended for aerosol generating procedures (e.g. suctioning) for all patients and for routine care of patients with Multi Drug Resistant TB (MDR- TB) and Extensively Drug Resistant TB (XDR-TB). HCWs visiting a patient in their own home should wear either a FFP2 or FFP3 mask in accordance with the above recommendations for FFP2 and FFP3 masks. Patient privacy must be maintained if mask is worn in the home. Apply the mask on entry into the home and remove mask on leaving the home. The FFP 2 and 3 masks must; Conform to EN Be fit tested. In order to be effective the mask must fit tightly to the wearers face, fit testing should be undertaken by a trained professional. HSE South (Cork and Kerry) Page 3 of 5

4 Be fit checked (i.e. the wearer must check that the mask fits properly on their face every time they enter the patient/resident area). Be put on before entering the isolation room. Changed when torn or damaged. Removed outside the isolation room. Gloves and a disposable plastic apron Gloves and a disposable plastic apron should be worn for all activities that involve direct contact with the patient/residents skin or surfaces and equipment in close proximity to the patient/resident (e.g. medical equipment, beside locker, bed rails etc). PPE should be put on before entering the patient s room. A fluid repellent gown should be worn when there is a risk of extensive exposure of clothing or skin, to blood, body fluids, excretions or secretions. PPE must be changed and hand hygiene performed in between different care activities on the same patient /client. PPE should be removed and hand hygiene performed before leaving the patients /residents room. PPE should be put on and removed as outlined in Appendix 2 Transmission Based Precautions section 6. PPE should be discarded immediately after removal in a healthcare risk waste bag. PPE and Visitors; Where visiting is essential, the visitor should be instructed how to put on a FFP2 mask prior to entering the residents/clients room. PPE and Residents/Clients; Where movement/transport of a resident/client is necessary; The resident/client should be encouraged to wear a surgical mask and instructed on respiratory hygiene and cough etiquette. Surgical masks if worn should be changed when heavily contaminated, wet with breath moisture or damaged. FFP2 or FFP3 masks are not recommended for use by residents/clients on Airborne Precautions. HPSC (2010) HSE South (Cork and Kerry) Page 4 of 5

5 Resident/Client Care Equipment Dedicate resident/client care devices e.g. thermometers, sphygmomanometers, stethoscopes to single client use. Use disposable equipment whenever possible otherwise ensure appropriate cleaning and decontamination of these devices with a neutral detergent and a chlorine releasing agent at 1,000 parts per million (ppm), or use a single step combined detergent and hypochlorite e.g. Chlor clean at 1,000ppm. Rinse and dry the device.. Environmental Hygiene Only take essential equipment and supplies into the room. Thoroughly clean the environment and all resident/client care equipment daily with a neutral detergent and a chlorine releasing agent at 1,000 parts per million (ppm), or use a single step combined detergent and hypochlorite e.g. Chlor clean at 1,000ppm. Rinse and dry the area/surface. Healthcare Workers TB is a notifiable disease. Once the Department of Public Health is notified of a case of TB, they will assess the risk of TB to people who have been in contact with the person who has TB. In the case of healthcare workers this will be carried out in liaison between the Department of Public Health, Occupational Health and Infection Prevention and Control. When this has been completed a decision will be made regarding who will need to be screened for TB. References and Bibliography Heymann, DL (2004) Control of Communicable Disease Manual. 18 th Edition. American Public Health Association. Immunisation Advisory Committee (2011) Immunisation guidelines for Ireland. Royal College of Physicians of Ireland. Health Protection Surveillance Centre (2010) Guidelines on the Prevention and Control of in Ireland Health Protection Surveillance Centre. Information on HSE South (Cork and Kerry) Page 5 of 5

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