TUBERCULOSIS TABLE OF CONTENTS TUBERCULOSIS CONTROL PLAN...2 ADMISSIONS...3 PROSPECTIVE EMPLOYEES...5 ANNUAL PERSONNEL SCREENING...5 EXPOSURE INCIDENTS...5 DOCUMENTATION OF OCCUPATIONAL EXPOSURE...5 PRE-PLACEMENT PULMONARY TUBERCULOSIS SCREENING...6 STATEMENT OF MEDICAL CLEARANCE... 7 Revised 1/2007 1
TUBERCULOSIS CONTROL PLAN PURPOSE: POLICY: To minimize employee exposure to, and subsequent infection with, tuberculosis (TB). This facility has adopted and will enforce the latest recommendations of the Centers for Disease Control and Prevention (CDC) regarding prevention of occupational transmission of TB among its employees. The following procedures reflect the CDC guidelines of 1994. PROCEDURE: 1. Administrative Controls A. Assignment of Responsibility B. Risk Assessment C. Admissions D. Prospective Employees E. Exposure Incidents F. Documentation of Occupational Exposure 2. Information and Training ASSIGNMENT OF RESPONSIBILITY: The Vice-President of Health Services is responsible for implementation of the Tuberculosis Control Program. The Site or Program Nurse may be delegated some of the responsibility under the direction of the VP of Health Services. Revised 1/2007 2
ADMISSIONS A. Prior to admission, documentation of Mantoux testing within the past six months is submitted to the program nurse. B. A client presenting without a documentation of Mantoux testing will be screened by a nurse using the Pre-Placement Pulmonary Tuberculosis Screening. C. If the screening determines a negative assessment and no TB-like symptoms are present, the child can be mainstreamed into the program. The nurse arranges for the child to receive a TST (Mantoux) within one business day. D. Screening for infection will consist of a TST (Mantoux) using 5 units of TST injected intracutaneously. E. For purposes of interpretation, a skin test reaction of > 10 mm induration is generally considered positive. F. Clients with a History of Positive Skin Test 1) Clients with a history of positive skin test will be assessed for symptoms of pulmonary TB. Documentation of Mantoux testing and treatment received must be presented prior to admission. 2) If the client does not have a documentation of Mantoux testing, the nurse will follow Step B as stated above. Hold the Mantoux testing until further consultation with a licensed physician. 3) If any symptoms suggestive of pulmonary TB are reported, a chest x-ray is a criterion for admission. 4) If initial chest x-ray is normal and the child remains asymptomatic and completes treatment, no further radiographs are required. 5) Any client with symptoms of pulmonary TB should not be admitted until disease is ruled out or the client is no longer infectious as indicated in writing by a licensed physician. 6) All skin-test positive clients shall be clinically evaluated on an annual basis with documentation regarding the presence or absence of symptoms consistent with tuberculosis. G. All cases of suspected or confirmed tuberculosis will be reported to the County Health Department. H. Potential employee exposure follow-up will be conducted as described under Revised 1/2007 3
"Exposure Incidents". I. If the physician determines that the child poses no current public health risk, he or she signs a statement indicating that the child is non-infectious. When a physician is not onsite, the nurse can take a verbal order for medical clearance. The verbal order is documented in the following three places: a. The Statement of Medical Clearance for Symptomatic Individual b. The Physician s Order Form c. The Nurse s Notes J. Repeat skin tests will be provided for TST negative clients after any suspected exposure to a documented case of active tuberculosis. In such an instance, a skin test conversion is defined as an increase of > 10 mm for a person less than 35 years of age. Following exposure, skin test converters will undergo chest x-ray and clinical evaluation for tuberculosis. K. CLIENT TRANSPORT Clients requiring transport while considered infectious with TB will be provided with a standard surgical mask for the containment of respiratory secretions. Revised 1/2007 4
PROSPECTIVE EMPLOYEES A. All qualified applicants for employment shall be screened for presence of infection with M. tuberculosis using the Mantoux TST. B. Individuals who test positive (TST > 10 mm) shall be referred either to their private physician or to the County Health Department for follow-up and/or treatment. A letter from the physician or Health Department attesting to the noninfectious nature of the applicant must be received prior to date of hire. C. Individuals with a documented history of a positive TST will not undergo skin testing. Such individuals will, however, be referred as in 2 above for follow-up. D. For purposes of interpretation, a skin test reaction of > 10 mm induration is generally considered positive. E. ANNUAL PERSONNEL SCREENING Only employees working at a DDD program with negative skin test history will have an annual TST) and, depending on the test results shall be followed as above. F. EXPOSURE INCIDENTS In the event of documented exposure to a diagnosed case of pulmonary TB, all exposed employees, as determined by the Nurse or consulting Nurse, will undergo the following: a. TST skin test, if previously TST negative. b. Follow-up TST in 10-12 weeks. If employee develops a positive skin test, a CXR will be obtained. c. All TST converters, regardless of CXR results, will be referred to their private physician or to the Health Department for follow-up. G. DOCUMENTATION OF OCCUPATIONAL EXPOSURE The occurrence of TB infection (positive TST) as well as active TB disease will be recorded on the OSHA 300 log for all employees except in those situations involving pre-employment screening. Revised 1/2007 5
Pre-Placement Pulmonary Tuberculosis Screening Client Name: Client Date of Birth: / / Name of RN completing assessment: Date of assessment: / / For any answer of yes, please contact the on-call physician or advanced practice nurse and complete the verbal order form Suspected Pulmonary Tuberculosis Question Yes No Unknown Has the child had any contact with any known case of TB? Was any household member born in or traveling in areas where TB is common (Africa, Asia, Latin America, Caribbean)? Does the child have regular contact with persons who are HIV infected, homeless, incarcerated, and/or are illicit drug users? Is the child known to be HIV positive? Does the child have a persistent cough, night sweats, chills, or hemoptysis? If yes, please circle those that apply Has the child ever had a positive PPD? Yes No Unknown Date: Signature of RN completing assessment / / Date of form completion Revised 1/2007 6
Statement of Medical Clearance for Symptomatic Individual Name of Client: Date of Evaluation: Although the presence of TB-like symptoms was confirmed on assessment, a chest radiograph and subsequent testing has ruled out the presence of communicable tuberculosis. I declare that the individual above has been fully evaluated and determined to be free of communicable tuberculosis disease. This individual poses no current health risk. Print Name of Physician Signature of Physician Verbal Order Obtained By: Date: Time: Revised 1/2007 7