SOP Number: 19.002
Review Date: Jan 15, 2003
Policy and Procedures for Occupational Exposure to Tuberculosis
- Purpose of Document
- Principals of Tuberculosis Control
- Preventing Spread of Infection
- Respiratory Protection
- Medical Surveillance
The United States Department of Labor has determined that occupational exposure to tuberculosis is a significant heath problem that requires employer action. Recently drug resistant strains of Mycobacterium Tuberculosis (TB) have become a serious concern and cases of multi-drug resistant tuberculosis (MDR-TB) have occurred in forty states. Mycobacterium Tuberculosis is carried through the air in infectious droplet nuclei of 1 to 5 microns in size. These droplet nuclei may be generated when a person with infectious TB disease coughs, speaks, sings, or spits. In an occupational setting, workers in close contact with persons with infectious tuberculosis disease are at risk of infection with TB. Certain high hazard medical procedures, which are cough inducing, may further increase the risk of infection in health care workers.
(Taken from Directorate of Compliance Programs Memorandum to Regional Administrators U.S. Department of Labor.)
Purpose of Document
The Student Health Facility at the State University of New York College at Plattsburgh is an outpatient facility offering medical services to a campus of more than five thousand students. It can be reasonably anticipated that the medical staff of this facility will at sometime come into contact with a patient or patients that test positive for Tuberculosis. This document contains procedure guidelines and policies established to protect the Health Care Workers of the College.
The known incidents of tuberculosis is higher in blacks, Asians and Pacific Islanders, American Indians and Alaskan Natives, Hispanics, current or past prison inmates, alcoholics, intravenous drug users, and persons living in the same household as members of these groups.
Mycobacterium Tuberculosis is carried in airborne particles called drop nuclei. These particles are generated when infected persons, speak, cough, sneeze or spit. Due to the small size of the particles (1-5 Microns) they remain airborne and can spread throughout the area. Infection occurs when a susceptible person breathes in the droplet nuclei and bacilli become established on the alveoli of the lungs from where it is spread to the rest of the body.
Principals of Tuberculosis Control
The Centers for Disease Control recommends that the following specific actions be taken to reduce the risk of tuberculosis transmission:
- Screening patients for active tuberculosis and tuberculosis infection.
- Providing rapid diagnostic services.
- Prescribing appropriate curative and preventive therapy.
- Maintaining physical measures to reduce microbial contamination of the air.
- Providing isolation rooms for persons with, or suspected of having, infectious tuberculosis.
- Screening health care facility personnel for tuberculosis infection and tuberculosis.
- Promptly investigating and controlling outbreaks.
"A diagnosis of tuberculosis should be considered for any patient with persistent cough or other symptoms compatible with tuberculosis, such as weight loss, anorexia, or fever." Diagnostic measures for tuberculosis should be instituted on these patients. The Clinton County Health Department should be notified of all known or suspected cases immediately.
Preventing Spread of Infection
- One examining room in the Student Health Center will be designed as the AFB (acid-fast bacilli) isolation room. This room will be identified by signage reading "AFB ISOLATION".
- General exhaust ventilation in this room will be monitored to ensure that the room is kept in a negative to prevent infiltration of the room atmosphere into the corridor or other parts of the building.
Designated members of the medical staff who will deal with suspected or known infected patients will be supplied with HEPA (high efficiency particulate air) filter respirators. The standard negative air respirator used is the 3M half Mask. These respirators will be fit tested every 6 months in accordance with the SUNY Plattsburgh Respiratory Protection Plan.
The standard powered air-purifying respirator used is the Racal Power Flow with HEPA filters. All respirator used will be cleaned and disinfected after each use. They must be stored in a clean, dry area and kept ready for immediate use. The health care providers must use these respirators when a known or suspected tuberculosis patient is being examined.
If a known or suspected tuberculosis patient must be transported, it can be done by an ambulance only. The caller will inform the dispatcher if the patient is or is not suspected of being tuberculosis positive.
The Centers for Disease Control recommend the following guidelines for cleaning, disinfecting, or sterilizing patient care equipment:
- Critical Items such as surgical instruments always require sterilization. Only disposable needles will be used.
- Semi-critical Items are items such as noninvasive flexible and rigid fiberoptic endoscopes or bronchoscopes, endotracheal tubes, or anesthesia-breathing circuits that may come into contact with mucous membranes but do not ordinarily penetrate body surfaces. Although sterilization is preferred for these instruments, a high-level disinffection procedure that destroys vegetative microorganisms, most fungal spores, tubercle bacilli, and small, nonlipid viruses may be used.
- Noncritical Items are those that do not ordinarily touch the patient or touch only skin contact. Such items include crutches, bedboards, blood pressure cuffs, and various other medical accessories. These items do not transmit tuberculous infection. Washing these items with a detergent is usually sufficient.
- Although microorganisms are normally found on walls, floors, and other surfaces, these environmental surfaces are rarely associated with transmission of infections to patients or health care facility personnel. This is particularly true with organisms such as tuberle bacilli, which generally require inhalation by the host for infection to occur. Therefore, extraordinary attempts to disinfect or sterilize environmental surfaces are rarely indicated.
- Routine daily cleaning procedures used for examination rooms should be carried out in the AFB Isolation area. The Colleges germicide/disinfectant mixed to the proper specifications will effectively clean and disinfect environmental surfaces.
All members of the medical staff designated for respiratory protection must have a Doctors Clearance on file in the Environmental Health Office stating that they have no condition which would preclude them from working while wearing a respirator. This clearance must be renewed annually.
In addition, preplacement evaluation, administration and interpretation of TB Mantoux skin tests, and periodic evaluations shall be offered to the health care personnel (at not cost to the employee) as follows:
An initial baseline screening at the time of employment; annually for all health care staff; re-testing every six months for workers with exposure. A past history of positive skin testing one of the following course of actions:
- If a course of prophylaxis is completed neither retesting or chest x-ray is required unless the worker becomes symptomatic.
- If the course of prophylaxis was not completed or given, that a chest x-ray is required every 2 years.
Employee exposure to TB will be recorded and kept on file in the Environmental Health Office along with:
- A record of TB skin testing results.
- Medical evaluation and treatment reports.
- Respirator fit test records.
- Doctors clearance for respirator use.
TB infections (positive TB Mantoux skin test) and TB disease are both recordable on the OSHA 200 log in the health care setting. If an employee's TB infection, which has been entered on the OSHA 200 log, progresses to TB disease during the five-year maintenance period, the original entry for the infection will be updated to reflect the new information.
Cathleen Eldridge, Associate Director
Office: Sibley Hall 421