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Effective infection control efforts are essential in preventing nosocomial transmission of TB. A hierarchy of control measures is recommended to prevent TB transmission in health care facilities.
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- Administrative Controls diff --git a/app/src/main/assets/pages/10_tb_infection_control_hospital_isolation_procedures__a__administrative_controls.html b/app/src/main/assets/pages/10_tb_infection_control_hospital_isolation_procedures__a__administrative_controls.html index a6227ff..9b3a116 100644 --- a/app/src/main/assets/pages/10_tb_infection_control_hospital_isolation_procedures__a__administrative_controls.html +++ b/app/src/main/assets/pages/10_tb_infection_control_hospital_isolation_procedures__a__administrative_controls.html @@ -15,19 +15,23 @@
- Patients with or at risk for TB need to be placed in Airborne Infection Isolation precautions upon admission (placed in a negative pressure airborne infection isolation [AII] room). +
- Unsuspected patients with active TB disease and misdiagnosis (especially among persons living with HIV who may have “atypical” or non-classical presentations) have led to nosocomial transmission at a number of hospitals (as well as at correctional institutions and other health care facilities). +
- + TB Surveillance in Georgia +
- - TB Surveillance in Georgia + How to Report TB as a Notifiable Disease +
- - TB Case Definitions for Public Health Surveillance + TB Case Definitions for Public Health Surveillance
- - Role of the Health Department + Role of the Health Department
- - Hospital Discharge Planning for Patients with Suspected or Proven TB + Hospital Discharge Planning for Patients with Suspected or Proven TB
- - The U.S.-Mexico Binational Tuberculosis Referral Program (CureTB) + Interjurisdictional TB Notification (IJN) - +
- + CureTB Program (International Linkage to TB Care) + +
- ALL Latent TB infection (LTBI) in children under 5 years of age must be - reported to the public health department in the county where the patient resides. - -
- A source Case Investigation will be conducted by the health department - when LTBI is found in a child under 5 years old. - -
- This data is analyzed to describe the distribution of the disease among Georgia’s population, identify high risk groups and TB clusters, and describe trends in morbidity, mortality, drug resistance patterns, treatment outcomes, and infection rates among contacts exposed to persons with active TB disease. +
- The data are used at state and local levels to guide policy and decision making, set priorities for program interventions, evaluate program performance for the prevention and control of TB in Georgia, educate key stakeholders and the general public on TB, and ensure continued funding for TB control efforts. +
- Georgia’s TB surveillance data are transmitted electronically to the U.S. Centers for Disease Control and Prevention (CDC) and become part of the national TB surveillance database. +
- Any person with confirmed active TB disease +
- Any person presumed to have active TB disease +
- Latent TB infection (inactive TB) in children under the age of 6 years +
- Any positive culture for M. tuberculosis, +
- Any positive smear for Acid Fast Bacilli (AFB), +
- Any positive nucleic acid amplification (NAA) test result for M. tuberculosis, +
- Treatment with two or more anti-tuberculosis medications, +
- Symptoms consistent with active TB disease and recent exposure to someone with active TB disease, +
- Symptoms consistent with active TB disease and a history of latent TB infection (inactive TB), +
- Symptoms consistent with active TB Disease and a positive tuberculin skin test (TST [TB skin test]) or TB blood test (interferon gamma release assay [IGRA]) for M. tuberculosis, or +
- An abnormal chest radiograph suggestive of active TB disease. +
- Latent TB infection (inactive TB) is indicated by: +
- A positive tuberculin skin test (TST [TB skin test]) or TB blood test (interferon gamma release assay [IGRA]) for M. tuberculosis, and +
- Confirmed or presumed active TB disease has been ruled out. +
- Administrative controls are most important and include measures to reduce the risk of exposure to persons with - infectious TB; this includes careful screening, early identification and treatment of patients with TB. A high - index of suspicion is critical. Patients with or at risk for TB need to be isolated upon admission (placed in a - negative pressure airborne infection isolation [AII] room). Unsuspected patients with active TB disease and - misdiagnosis (especially among HIV-infected patients who may have “atypical” or non-classical presentations) - have led to nosocomial transmission at a number of hospitals (as well as at correctional institutions and other - health care facilities).
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+ Administrative controls are most important and include measures to reduce the risk of exposure to persons with infectious TB; this includes careful screening, early identification and treatment of patients with active TB disease.
+ A high index of suspicion is critical.⌃ +-
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Grady Memorial Hospital in Atlanta has prevented nosocomial transmission in large part by the effective use of administrative controls. Careful screening of patients and isolation of those at risk for TB have been accomplished by the introduction of an expanded respiratory isolation policy.
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In general, the risk of occupational acquisition of TB is low among the large majority of US health care workers - (HCWs) given the changing epidemiology of the disease in the U.S. The risk of TB exposure among most US-based - health care workers (HCWs) is similar to the general population given the decreased TB incidence and improved - hospital infection control measures in this country. Given the low risk among the vast majority of US HCWs, - serial TB testing for US-based HCWs has been associated with a high rate of false-positive conversions. - Therefore, CDC guidelines were updated in 2019 and no longer recommend routine serial testing for most US-based - HCWs [MMWR Morb Mortal Wkly Rep 2019;68:439–44.]. Guidelines continue to recommend baseline screening and - testing in addition to an individual TB risk assessment to aid in TB test interpretation. All HCWs should have - baseline test for LTBI (unless documented to be previously TST or IGRA positive or documented to have had prior - TB disease). Two-step tuberculin skin testing upon employment is recommended unless the HCW had a TST in the - prior year. Updated guidelines suggest health care facilities may consider serial testing in selected - situations, such professionals at increased risk for exposure or selected areas in the facility where - transmission has occurred and/or infection control lapses occur and infectious patients were present. If serial - testing of HCWs is needed, we recommend the use of the TST rather than an IGRA for reasons described above (see - pages 19—21 ). HCWs should be educated about the basic concepts of TB transmission and pathogenesis, infection - control practices, signs and symptoms of TB, and risk for TB exposure in the facility annually.
-- Following exposure, HCWs should be evaluated for signs and symptoms of TB. Those with a negative baseline test - and no prior LTBI or TB should have a TST (or IGRA) performed. If the test is negative, a repeat test 8-10 weeks - after the last exposure is recommended.
-+ (HCWs) given the changing epidemiology of the disease in the U.S.
++ The risk of TB exposure among most US-based health care workers (HCWs) is similar to the general population given the decreased TB incidence and improved hospital infection prevention and control measures in the U.S. +
+Given the low risk among the vast majority of US HCWs, serial TB testing for US-based HCWs has been associated with a high rate of false-positive conversions. Therefore, CDC guidelines were updated in 2019 and no longer recommend routine serial testing for most US-based HCWs [MMWR Morb Mortal Wkly Rep 2019;68:439–44.]. Guidelines continue to recommend baseline screening and testing in addition to an individual TB risk assessment to aid in LTBI diagnostic test interpretation.
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+ All HCWs should have baseline test for LTBI (unless documented to be previously TST or IGRA positive or documented to have had prior TB disease). If the TST is used, two-step tuberculin skin testing upon employment is recommended unless the HCW had a TST in the prior year.
+ +Updated guidelines suggest health care facilities may consider serial testing in selected situations, such professionals at increased risk for exposure or selected areas in the facility where transmission has occurred and/or infection control lapses occur and infectious patients were present.
+ ++ If serial testing of HCWs is needed, we recommend the use of the TST rather than an IGRA because of high rates of false positive IGRA tests when serial testing of low risk US health care workers was performed as described above (see pages 19—21 ). +
+ ++ Following a TB exposure from a patient with infectious TB not in Airborne Infection Isolation Precautions, HCWs should be evaluated for signs and symptoms of TB. Those with a negative baseline test and no prior LTBI or TB should have a TST (or IGRA) performed. If the test is negative, a repeat test 8-10 weeks after the last exposure is recommended.
+Any worker who develops symptoms of active TB disease or whose test for LTBI (TST or IGRA) converts to positive should be evaluated promptly. Health care workers with recent TB infection on the basis of a conversion to a positive test for LTBI (regardless of age) and no evidence of active disease should be encouraged to take @@ -46,7 +46,7 @@
| Grady Hospital TB Isolation Policy | +Grady Hospital TB Isolation Policy |
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