TB in the Correctional Setting Florence, Arizona October 7, 2014 Vincent Gales, RN, BSN, CCHP October 7, 2014 Vincent Gales, RN, BSN, CCHP has the following disclosures to make: No conflict of interests No relevant financial relationships with any commercial companies pertaining to this educational activity 1
Vincent Gales, RN, BSN, CCHP 10/22/2014 Objectives Explain When a Tuberculosis (TB) Patient Can Be Considered Noninfectious. Determining TB Patient Infectiousness Isolation versus Segregation Assessing When the Patient May Be Released from Isolation Transportation of Inmates 2
Objectives Identify the Components of an Effective Program Administrative Environmental Personal Respiratory Protection Determining TB Patient s Infectiousness Frequency and Strength of Cough Positive Sputum Smear Laryngeal TB Cavitary TB 3
Determining TB Patient s Infectiousness (continued) Smaller Volume Shared Airspace Greater Duration of Exposure Untreated or Just Starting Treatment Isolation versus Segregation Isolation is used to keep those who have or are suspected of having a communicable disease, away from others a Segregation is used to keep detainees away from others 4
Criteria for Patients to Be Considered Noninfectious Patients can be considered noninfectious when they meet all of the following three criteria: They have three consecutive negative AFB sputum smears collected in 8 hour intervals (at least one being an early morning specimen); Their symptoms have improved clinically (for example, they are coughing less and they no longer have a fever); and They are compliant with an adequate treatment regimen for 2 weeks or longer Transportation of Inmates Patients with suspected or confirmed infectious TB disease should be transported in an ambulance whenever possible Ambulance should have their own airborne precaution protocols 5
Transportation of Inmates Facility Transportation Vehicle No other patients transported at the same time Patient in back, Staff in front Ventilation on high, Recirculation off Staff wear N-95 Mask Patient wear a surgical or procedure mask Administrative Controls Reduce the Risk of Exposure Assign someone the responsibility and authority for TB infection control in the correctional setting Conduct a TB infection control risk assessment of the setting Develop and institute a written TB Plan to ensure prompt detection & separation from others (into an AII room if possible) 6
Administrative Controls Treatment of persons who have suspected or confirmed TB disease Test inmates and staff who are at risk for exposure to TB disease Educate, train, and counsel healthcare workers, patients, and visitors about TB infection and disease Environmental Controls Prevent Spread and Reduce Concentration of Droplet Nuclei Use mechanical ventilation equipment to circulate and move air in a building Use local exhaust ventilation (e.g., hoods, tents, or booths) High Efficiency Particulate Air (HEPA) filtration & Ultraviolet Germicidal Irradiation (UVGI) Airborne Infection Isolation (AII) AFB (shown in red) are Tubercle Bacilli 7
Personal Respiratory Protection Further Reduce Risk of Exposure in Special Areas and Circumstances Particulate Respirator Masks N95 Entering respiratory isolation room Transporting a contagious patient Performing cough inducing procedures Technol N95 Particulate Respirator Personal Respiratory Protection (continued) Respiratory Protection Program Required in facilities covered by the Occupational Safety and Health Administration (OSHA) Responsible party assigned Covered staff receive training, medical evaluation and fit testing 8
Summary Explained when a TB patient can be considered noninfectious Identified the components of an effective infection control program Questions 9