Download Airborne Pathogens

I N T RO D U C T I O N TO H E A LT H C A R E
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….
 Talking
 Coughing
 Breathing
 Laughing
 Singing
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.
TUBERCULOSIS
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.
TYPES OF EXPOSURE
Tuberculosis Infection
 Also called
Latent or Inactive Tuberculosis
Tuberculosis Disease
 Also called
Active Tuberculosis
TUBERCULOSIS INFECTION
Can be present if…
You have the TB organism in your body
You do not look or feel ill
You test positive on a TB Skin Test
Can be treated with…
One drug therapy
The 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 loss
 Loss of energy
 Poor appetite
May develop if you do not receive treatment for infection
You must receive more than one drug therapy
Drug 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.
TUBERCULOSIS IN THE U.S.
•
•
•
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.
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.
TUBERCULOSIS IN THE U.S.
•
•
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 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 ANSWERS
1. Coronary Artery Disease
2. Strokes and other Cerebro-vascular Diseases
3. Lower Respiratory Infections
4. Chronic Obstructive Pulmonary Disease
5. Diarrheal Disease
6. HIV/AIDS
7. TUBERCULOSIS
8. Lung Cancers
9. Road Traffic Incidents
10. 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.
TUBERCULOSIS FACTS
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
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.
THOSE WITH INCREASED RISK FACTORS FOR
TUBERCULOSIS…
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.
TUBERCULOSIS SIGNS & SYMPTOMS
o
o
o
o
o
o
o
o
o
Persistent cough
Fever
Malaise
Night Sweats
Fatigue
Loss of Appetite
Weight Loss
Chest Pain
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 patient
Treatment with drugs usually lasting between
6-12 months.
TREATMENT FOR TB DISEASE
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.
2.
3.
4.
Isoniazid (i-so-ni-a-zid)
“INH”
Rifampin (ri-fam-pin)
Ethambutol (eth-am-byootol)
Pyrazinamide (peer-a-zin-amide)
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 setting
 Population served
 Job category
 Health 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 TB
Environmental considerations also influence
transmission:
o Volume of shared air space
o Amount of ventilation
o Presence or absence of sunlight which kills TB
bacteria.
o Humidity in room
o 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"
WHAT IS NEGATIVE AIR PRESSURE ROOM?
oAir flows INTO the room from the
corridor
oAir inside the room is changed with a
recommendation of 12 x /hour.
oAir is exhausted directly to the outside
through HEPA filters, making the
exhausted air harmless to the outside,
oIf not exhausted to outside, air must
be forced through particulate filters.
oDoor should always stay closed and
room identified as AFB isolation 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 TUBERCULOSIS
What happens when an employee is exposed to
TB at work?
Tuberculosis exposure incident report.
Skin Testing
Medical Evaluation
Indicated Treatments
Special 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 skin
 Examined in 48-72 hours
 Results are determined by size of the hard area under
skin (induration)---NOT by redness