Transcript Bloodborne infections - Scioto County Medical Society

Blood borne pathogens seminar
Blood borne infections and tuberculosis:
management of occupational exposure and
isolation precautions
Valerie Fletcher, M.D.
Blood borne pathogens

Microorganisms that are present in human blood and can cause
disease in humans.

Pathogens include, but are not limited to, hepatitis B virus
(HBV) and hepatitis C virus (HCV) and human
immunodeficiency virus (HIV).

HBV, HCV and HIV may cause major occupational blood borne
infections that are potentially fatal.

The risk of infection after exposure depends on several
factors including:
- the pathogen involved
- the type of exposure
- the amount of blood or infectious material involved in
the exposure
- and the amount of virus in the infectious material at
the time of exposure.

Risk of acquiring infection after percutaneous injury with a
contaminated hollow-bore needle are HBV > HCV > HIV.

Most exposures to infectious material do not lead to
infections.

Most occupational exposures occur among health care workers
(HCWs).

> 8 million US HCWs may be exposed to blood or infectious body
fluids.

~ 800,000 percutaneous injuries occur per year in hospitals and
other healthcare facilities.

44 percutaneous injuries reported at SOMC in 2004, 38 in 2005.
Body Fluid Exposure Type – SOMC, 2004 - 2005
35
30
25
20
15
10
5
0
Needlestick
Splash
Cut
2004
2005
Bite
Other
Body fluid exposures – SOMC, 2004 - 2005
14
12
10
8
6
4
2
0
Surg
ER
ICU
MCU
3N
1W
2004
2005
Mat
Lab
HK
Resp
Sec
Percutaneous injuries – SOMC, 2004 - 2005
14
12
10
8
6
4
2
0
ER
Sur
MCU
2004
ICU
2005
3N
Mat
Lab
Distribution of 10,378 reported percutaneous injuries
among hospital workers by medical device associated with
injury
1995 – 2000 (CDC)
Distribution of 6,212 reported percutaneous injuries involving hollowbore needles in hospital workers by associated medical procedure
1995 – 2000 (CDC)
Isolation Precautions

Standard precautions – precautions designed to prevent
transmission of HIV, HBV, HCV and other blood borne
pathogens when providing first aid or healthcare.

Blood and certain body fluids of ALL patients are considered
potentially infectious.

Standard precautions involve the use of protective barriers such
as gloves, gowns, masks or protective eyewear which can
reduce the risk of exposure of the skin or mucous membranes
of HCWs to potentially infectious materials.

Precautions to prevent injuries caused by needles, scalpels and
other sharp instruments also included.
Potentially infectious materials

blood

semen

vaginal secretions

cerebrospinal fluid

synovial fluid

pleural fluid

peritoneal fluid

amniotic fluid

saliva (if contaminated with blood)

any body fluid that is visibly contaminated with blood
Standard precautions
(MMWR August 21,1987)

HCWs should routinely use appropriate barrier precautions to
prevent skin and mucous membrane exposure when contact
with blood or body fluid of any patients is anticipated.

Hands and other skin surfaces should be washed immediately
and thoroughly if contaminated with blood or other body fluids.
Hands should be washed immediately after gloves are
removed.

HCWs should take precautions to prevent injuries caused by
needles, scalpels and other sharp instruments or devices
during procedures; when cleaning used instruments, during
disposal of used needles and when handling sharp instruments
after procedures.

Mouthpieces, resuscitation bags, or other ventilation devices should
be available for use in areas in which the need for resuscitation is
predictable.

HCWs who have exudative lesions or weeping dermatitis should
refrain from all direct patient care and from handling patient care
equipment.

Pregnant HCWs are not known to be at greater risk of contracting
HIV infection than HCWs who are not pregnant; however if a HCW
develops HIV during pregnancy, the infant is at risk of infection
resulting from perinatal transmission. Pregnant HCWs should
therefore be especially familiar with and strictly adhere to
precautions to minimize the risk of HIV transmission.
Engineering and Work Practice Controls

Standard precautions are used at all times in caring for all patients.

Handwashing facilities (or alcohol-based hand rub) are readily
accessible to all employees.

Eating, drinking, smoking, applying cosmetics and handling contact
lenses are prohibited in areas where there is a reasonable likelihood
of occupational exposure.

Food and drink should not be kept in refrigerators, freezers, shelves,
cabinets or on countertops where blood and body fluids may be
present.

Mouth pipetting/suctioning of blood or other potentially infectious
materials is prohibited.

Specimens of blood or other potentially infectious materials should
be placed in a container which prevents leakage during collection,
handling, processing, storage, transport or shipping.

Personal protective equipment, appropriate to the situation, should
be used in all situations in which there is a reasonable likelihood of
occupational exposure.

A 1:1 dilution of bleach (sodium hypochlorite) is an appropriate
disinfecting agent.

Broken glass is never picked up with hands, even if wearing gloves.
Use an appropriate sweeping device and pan to collect pieces of
glass.
Hand hygiene
HANDWASHING IS THE SINGLE MOST IMPORTANT MEANS OF
PREVENTING THE TRANSMISSION OF INFECTION.
Handwashing

Hands are wet with running water.

Lather with soap for at least 15 seconds.

Rinse hand with running water.

Dry hands with disposable towel.

Turn off tap with disposable paper towel.

Place disposable towel in appropriate container.
Waterless alcohol-based hand rub or rinse

Approx. 3 ml of product taken from dispenser and rubbed
on dry skin for about 30 sec until alcohol evaporates.

Effective only on areas in contact with rub or rinse.

Does not remove soil or organic material.

Contains 60 -70% alcohol.

Contains a moisturizer to prevent drying of skin.

Waterless alcohol-based rubs are recommended for areas
in which sinks for hand washing are not readily available.

Alcohol-based rubs have been shown to be superior to
plain soap for hand washing because of the antimicrobial
effect.

Alcohol-based rub does not replace hand washing for
visibly soiled hands.
Personal protective equipment (PPE)

Specialized clothing or equipment worn by employee for protection
against contamination with blood or body fluids which may transmit
infectious agents.

General work clothes not intended to function as ‘protective clothing’
are not considered to be PPE.

PPE can fail. Standard precautions and careful attention while
performing all patient care duties will minimize the risk of personal
contamination.

PPE is considered appropriate if it does not allow blood or other
potentially infectious material to pass through it and reach the
employee’s clothing, undergarments, skin and mucous membranes
under normal condition of use and for the duration of time for which
the protective equipment is to be used.

PPE sufficient to provide an appropriate protective barrier should be
readily available to all employees. The use of PPE is required in all
situations in which there is a reasonable possibility of contamination
with blood or other potentially infectious material.

PPE are gloves, masks, isolation gowns, laboratory coats, aprons,
face shields, goggles, ventilation devices, shoe covers, hats and
hoods.
Gloves

Should be worn when it can be reasonably anticipated that an
employee may have hand contact with blood, other potentially
infectious materials, mucous membranes and non-intact skin,
when performing vascular access procedures and when
handling or touching contaminated items or surfaces.

Disposable (single use) gloves should be used for all patient
care functions and procedures. Hand are washed before
putting on gloves and immediately following removal of the
gloves.

Gloves must be changed and hands washed between patients.

Following use of gloves, they should be disposed of in an
appropriate biohazard container. Used gloves are to be
considered contaminated.

Disposable gloves are not to be washed or in any way cleaned
for reuse.

Utility gloves are preferable for housekeeping tasks. Utility
gloves may be decontaminated for reuse. They should be
discarded if cracked, peeling, torn, punctured, or show signs of
deterioration or excessive wear.

If, during a procedure or task, a glove is punctured, torn or its
ability to function as a barrier is in any way compromised, the
glove should be removed as soon as feasible. Hands are then
washed and inspected for possible puncture or damage to the
skin, and a new glove is put on. Punctures or skin breaks
should be reported.

Gloves are used for touching blood and body fluids requiring
universal precautions, mucous membranes, or non-intact
skin of all patients.

for handling items and surfaces soiled with blood or body
fluids to which universal precautions apply.

for performing phlebotomy when HCW has cuts, scratches,
or other breaks in his/her skin, or if hand contamination with
blood may occur; when receiving training in phlebotomy.

when performing finger and/or heel sticks on infants or
children.
Masks, Eye Protection, Face Shields

Masks in combination with eye protection devices (goggles, glasses
with solid side shields, or chin-length face shields) should be worn
whenever splashes, spray, splatter or droplets of blood or other
potentially infectious materials may be generated and eye, nose or
mouth contamination can be reasonably anticipated.

Glasses are preferable to contact lenses for heath care workers who
have potential exposure to blood borne pathogens.

Masks and eye protection are not necessary for those tasks in which
aerosols are not likely to occur such as venipuncture and suture
removal.

Mask and eye protection should be used for dental procedures in
which aerosols may be created.
Surgical masks
Protective eyewear
Gowns, Aprons, and Protective Body Clothing

Appropriate protective clothing such as, but not limited to,
gowns, lab coats, aprons, clinic jackets or similar outer
clothing should be worn when it is reasonably anticipated
that contamination with blood or other infectious materials
may occur. The type of garments will depend on the task and
the degree of exposure anticipated.

In general, extreme barrier precautions (surgical caps, shoe
covers, and hoods) are necessary in instances in which
gross contamination is reasonably anticipated.

In are office setting, impervious disposable gowns are, in
general, adequate.
Housekeeping

If a surface becomes contaminated, clean IMMEDIATELY.

Use Standard Precautions including appropriate barriers.

Clean gross contamination with disposable towel or larger implement.

Wash contaminated area with detergent and hot water.

Disinfect surface by spraying or flooding with approved disinfectant.

Dry area with disposable towel.

At the end of the work day, all surfaces that may have been
contaminated should be cleaned and disinfected.

Protective covers should be replaced as soon as feasible after
contamination.

Contaminated covers and disposable cleaning agents should be
disposed of in suitable containers for contaminated wastes.

All bins and other receptacles for reuse that have a reasonable
likelihood of being contaminated should be inspected and
decontaminated on a regular basis.
Dental Operatories

Dental operatories should be cleaned between patients, and
disposable items discarded.

Surfaces should be cleaned and disinfected.

Soiled dressings, packing material, removed sutures, dental wires
and appliances, removed teeth and tissue should be considered
contaminated, and disposed of appropriately.

Used reusable dental instruments should be cleaned and sterilized.

All needles and disposable sharps should be handled in accordance
with Standard Precautions.
Disposal of sharps

Appropriate sharps containers must be available in all patient
areas. They must have appropriate “BIOHAZARD” labeling.

All sharps are to be placed in these containers IMMEDIATELY
following use.

If sharps container is punctured or leaks, it is to be placed in
another impervious container which is labeled with the
appropriate “BIOHAZARD” label.

SHARPS CONTAINERS SHOULD NOT BE ACCESSIBLE TO
PATIENTS, ESPECIALLY CHILDREN.

Sharps containers should not be overfilled.

They must be kept in an upright position.

Full sharps container are never to shaken to settle the contents.

Transport of sealed sharps containers is to be done in accordance
with polices regarding transport of infectious waste.

Needles are never to be cut, bent, broken, or reinserted by twohanded method (recapped) into their original sheaths.
Sharps container
Exposure to saliva

Practices to minimize exposure to saliva include use of
gloves for digital examination of the mucous membranes
and endotracheal suctioning.

Handwashing after exposure to saliva.

Minimizing the need for emergency mouth-to-mouth
resuscitation by making mouthpieces and other
ventilation devices available for use in areas where the
need is predictable.
Ventilation masks
Pocket ventilation mask
Laundry

All laundry that is visibly contaminated, or that has a reasonable
likelihood of being contaminated, should be considered contaminated.

Contaminated laundry should be handled as little as possible.

Standard precautions should be observed at all times when handling
contaminated laundry.

Contaminated laundry should be placed in
impervious containers or bags at the location
in which it is used.

Contaminated laundry should not be sorted or rinsed in the location
of use.

It should be placed and transported in bags or containers that are
readily identifiable as containing contaminated items. These bags or
containers must be able to prevent leakage of fluid.

BIOHAZARD labeling is not required if standard precautions are
used when handling all soiled laundry, provided that all employees
can readily recognize containers holding soiled laundry.

Appropriate PPE should be available to all employees who have
contact with contaminated laundry.
Labeling of Potentially Hazardous Materials

All containers of regulated waste, refrigerators, and freezers
containing blood and other potentially infectious material and other
containers used to store, transport, or ship blood or other potentially
infectious material should be clearly labeled with an international
biohazard label symbol or placed in a red bag or red container which
meets the requirements of the policies for handling trash or
infectious waste.

Equipment which has been exposed to possible contamination by
blood or other potentially biologically hazardous material should be
labeled in an easily visible manner with a biohazard label specifically
referencing the area of the equipment which is contaminated.
Equipment so labeled should then be handled in accordance with
the local housekeeping policy on potentially contaminated
equipment.

All employees should practice Standard Precautions and comply
with the specific requirements of the local policy for handling trash
and infectious waste, when exposed to any biological waste or
potentially biological contaminated equipment.
Management of Occupational Blood Exposure

Provide immediate care to the exposed site
- wash wounds and skin with soap and water
- flush mucous membranes with water

Determine risk associated with exposure by
- type of fluid (eg blood, visibly bloody fluid, other
potentially infectious fluid or tissue, and concentrated
virus)
- type of exposure (ie percutaneous injury, mucous
membrane or nonintact skin exposure, and bites
resulting in blood exposure)

Evaluate exposure source
- Assess the risk of infection using available information
- Test the known sources for HBsAg, anti-HCV, and HIV
antibody
- For unknown sources, assess risk of exposure to HBV,
HCV or HIV infection
- Do not test discarded needles or syringes for virus
contamination.

Evaluate the exposed person
- Assess immune status for HBV infection (ie by history of
hepatitis B vaccination or vaccine response)
EXPOSURE REPORT
45
40
35
30
Total
25
20
Hepatitis A
15
10
5
Hepatitis B
Hepatitis C/ NANB
0
1952
54
56
58
1960
62
64
66
68
1970
72
74
76
78
1980
82
84
86
88
1990
92
94
96
98
2000
Reported cases per 100,000 population
Acute Viral Hepatitis A, B and C/NANB by Year, United States, 1952-2000
Year
Hepatitis B and C in Scioto County
80
Number of cases
70
60
50
40
30
20
10
0
2002
2003
Hep B
2004
Hep C
2005
Hepatitis

Hepatitis B virus (HBV) and hepatitis C virus (HCV) may cause
severe liver disease.

Symptoms of acute infection include nausea, vomiting,
abdominal pain and jaundice.

HBV becomes chronic in ~ 20% of infected patients.

HCV becomes chronic in ~ 80% in infected patients.

Chronic infection may be asymptomatic
Hepatitis B

The risk of acquiring HBV infection from a single needle-stick
contaminated with HBV-infected blood ranges from 6 – 30%.

Risk of transmission depends on the HBeAg status of the
source; HBeAg-positive patients have more circulating viruses
and are more infectious.

There is a risk of infection after exposure of mucous
membranes or non-intact skin.

No known risk of infection from exposure to intact skin.
Estimated number of occupational hepatitis B infections
among US health care workers, 1983 – 1999 (CDC)
Recommended PEP for exposure to HBV
Treatment
Vaccination and
antibody response
status of exposed
workers
Source HBsAg
positive
Source HBsAg
negative
Source unknown or
unavailable for
testing
HBIG x 1 and initiate
HB vaccine series
Initiate HB vaccine
series
Initiate HB vaccine series
No treatment
No treatment
No treatment
-known non-responder
HBIG x 1 and initiate
revaccination
or HBIG x 2
No treatment
If known high risk source,
treat as if source HBsAg
positiive
Antibody response
unknown
Test exposed person.
No treatment if HBsAb
positive.
If inadequate antibody
titer, administer HBIG
x1 and vaccine booster
No treatment
Test exposed person for
HBsAb. No treatment if
HBsAb positive.
If inadequate antibody
titer, administer vaccine
booster and re-check titer
in 1 – 2 month
Unvaccinated
Previously vaccinated
- known responder

Perform follow-up anti-HBs testing in persons who receive
hepatitis vaccine.

Test for anti-HBs 1 – 2 months after last dose of vaccine.

Anti-HBs response to vaccine cannot be ascertained if HBIG
was received in the previous 3 – 4 months.
Hepatitis C

The risk of HCV infection after needle-stick exposure to HCVinfected blood ranges from 1-3%.

Transmission may occur after exposure of mucous membrane or
non-intact skin.

No known risk from exposure to intact skin.

No estimates of the number of HCWs occupationally infected with
HCV.

~1% of HCWs are infected with HCV, and ~3% US population have
evidence of infection.

Perform baseline and follow-up testing for anti-HCV and
alanine aminotransferase (ALT) 4 – 6 months after
exposure.

Perform HCV RNA at 4 – 6 weeks if earlier diagnosis of
HCV infection desired.

Confirm repeatedly reactive anti-HCV results with
supplemental tests.

Post-exposure prophylaxis (PEP) not recommended.
Human Immunodeficiency Virus

HIV infects different cells (eg lymphocytes) in the body and weakens
the immune system.

Infection may be asymptomatic for several years.

~ 1 million persons in USA infected with HIV.

~ 500,000 people in USA have died as a result of HIV disease.

Symptomatic HIV infection (HIV disease) occurs as the infected CD4
lymphocytes are depleted.

Manifestations of HIV disease include uncommon cancers and
severe infections with typical and atypical pathogens.

Acquired immunodeficiency syndrome (AIDS) is defined as CD4
< 200, or occurrence of certain opportunistic infections or cancers.
Health care workers and occupational exposure to
HIV

57 documented HIV infections among HCWs after occupational
exposure up to December 2001.

138 possible cases of HIV infection among HCWs due to
occupational exposure.

49 (86%) HCWs with occupational HIV exposed to blood.

88% had percutaneous injury.

8 patients acquired HIV after muco-cutaneous exposure.

55 known source patients (HIV seropositive).

38 (69%) source patients had AIDS.

6 (11%) source patients had asymptomatic HIV infection.

18 source patients were on antiretroviral therapy at the time of
HCW exposure.

8 (14%) HCWs acquired HIV infection despite PEP.

3 infections occurred after 1996, when combined antiretroviral
therapy was introduced. 2 exposed HCWs had no PEP and
one was exposed to multi-drug resistant (MDR) HIV.

PEP does not always prevent infection.

Continue to emphasize avoidance of exposure.
Distribution and number of documented cases of occupational
transmission of HIV among health care workers by occupation,
1981 – 2002 (CDC)
Determining the need for HIV PEP after occupational exposure
(CDC)
STEP 1
Infectious source material
Yes
No PEP needed
No
What type of exposure has occurred
Mucous membrane
or non-intact skin
Intact skin*
Percutaneous exposure
No PEP needed
Volume
Severity
STEP 2
What is the HIV status of the exposure source
HIV negative
HIV positive
Status
unknown
No PEP needed
Lower titer
exposure
Higher titer exposure
Source
unknown
HIV Post-Exposure Prophylaxis

Basic regimen:
zidovudine (AZT) 300mg bid + lamivudine (3TC) 150mg bid
x 28 days

Expanded regimen:
Basic regimen
+
Kaletra (lopinavir/ritonovir)
{or atazanavir (Reyataz)
or indinavir (Crixivan)
or nelfinavir (Viracept)
or efavirenz (Sustiva)}
x 28 days

Initiate PEP as soon as possible, preferably within 2
hours of exposure.

Offer pregnancy testing to all women of childbearing age
not known to be pregnant.

Seek expert consultation if viral resistance is suspected.

Administer PEP for 4 weeks if tolerated.

Perform HIV antibody testing for at least 6 months postexposure
(baseline, 6 weeks, 3 months, and 6 months)

Perform HIV antibody testing if illness compatible with an acute
antiretroviral syndrome occurs.

Advise exposed persons to use precautions to prevent secondary
transmission during the follow-up period.

Evaluate exposed persons taking PEP within 72 hours after
exposure and monitor for drug toxicity for at least 2 weeks.
Confidentiality and legal issues

HIV tests are done after verbal or written consent.

HIV tests may be done on source patients in Ohio without
consent.

Person being tested may be identified by name or a code.

Patients to be tested are counseled before testing.

Testing and test results are confidential.
Tuberculosis

Mycobacterium tuberculosis is spread by airborne particles
which can be generated when a person with pulmonary or
laryngeal TB coughs, sneezes, shouts or sings.

The particles are 1 – 5 µm and can be kept airborne for
prolonged periods by normal air currents.

Particles may be spread around a room or building unless
contained.

Infection occurs when a person without immunity to TB inhales
airborne droplets containing M. tuberculosis.

Typical primary infection in adults is clinically and radiologically
silent (latent).

Latent tuberculosis infection (LTBI) is contained. Viable bacteria may
lie dormant in granulomata for years without reactivation.

Persons with LTBI do not have active tuberculosis and do not
transmit the infection to others.

Immunocompetent patients with LTBI have a positive tuberculin test.

Active pulmonary tuberculosis may present with slowly
progressive constitutional symptoms of malaise, anorexia,
weight loss, fever and night sweats.

Respiratory symptoms include chronic cough with production of
sputum which may be blood-tinged.

Difficulty in breathing may be experienced in extensive disease.

Persons with active infection may be asymptomatic.

Extra-pulmonary tuberculosis may involve lymph nodes, GI
tract, kidneys and brain.
Tuberculosis in Scioto County
40
35
Number
30
25
20
15
10
5
0
2001
2002
2003
2004
2005
Year
Active Cases
Number of patients on preventative therapy

CXR – infiltrates, cavities, lymph nodes, pleural effusion,
calcified granulomata.

Lab diagnosis – mycobacterial (AFB) smear and culture,
susceptibility testing, M. tuberculosis PCR.

M. tuberculosis grows slowly (6 -8 weeks in the lab)
HIV and TB

More susceptible to infection at any CD4 lymphocyte count.

Patients with HIV are more likely to progress to active disease after
infection.

Extra-pulmonary TB more common.
• Tuberculin skin test may not be reliable (anergy).
• Positive TST is ≥ 5mm.
• CXR atypical in severely immunosuppressed.
• Duration of treatment may exceed 6 months.
Multi-drug resistant tuberculosis

TB that is resistant to the first-line antibiotics of isoniazid,
rifampin, ethambutol and pyrazinamide.

Resistance occurs if TB is incompletely treated eg nonadherence to usual antibiotic regimen.

More commonly seen in patients with HIV.

Associated with increased mortality because of delay in
appropriate therapy and paucity of effective antibiotics.

Treatment includes use of intravenous and intramuscular
antibiotics and may exceed 12 months.
Tuberculin skin test

The tuberculin skin test (TST) (PPD) becomes positive 2 – 12
weeks after infection.

M. tuberculosis infection becomes latent in most cases (LTBI)
(mycobacteria are present in the body but produce no
symptoms).

Persons with LTBI are not infectious.

Some persons who are infected will develop TB disease (active
infection) and may be infectious.
Tuberculin Skin Test (TST)
Changes in Guidelines for Prevention of Transmission of
Mycobacterium Tuberculosis in Health-Care settings

The term “Tuberculin skin test” (TST) used instead of purified protein
derivative (PPD).

Whole-blood interferon gamma release assay (QuantiFERON®-TB
Gold test [QFT-G]) is FDA-approved for testing cell-mediated
immune reactivity to MTB, and may be used instead of TST in TB
screening programs for HCWs.

Frequency of TB screening for HCWs has been decreased in
various settings, and the criteria for determination of screening
frequency has been changed.

The scope of settings in which the guidelines apply has been
broadened to include laboratories and additional outpatient and
non-traditional facility settings.

These recommendations usually apply to an entire healthcare
setting rather than areas within a setting.

New terms, airborne infection precautions and airborne
infection isolation room, are introduced.

Recommendations for annual respirator training, initial respirator fit
testing, and periodic respirator fit testing have been added.

Information on ultraviolet germicidal irradiation and room-air
recirculation units has been expanded.

Additional information regarding MDR TB and HIV infection have
been included.
Quantiferon Gold – Blood Assay for M. tuberculosis
(BAMT)

Whole blood assay to measure the body’s response to 2 MTB
proteins.

Single blood draw.

No need for a 2 step test.

Not subject to reader bias.

Not affected by prior BCG.

Aids in the diagnosis of MTB infection
Characteristics of a patient with TB disease
that increase the risk for infectiousness








Presence of a cough
Cavitation on CXR
Positive acid-fast bacilli (AFB) sputum smear results.
Respiratory tract disease with involvement of the larynx.
Respiratory tract disease with involvement of the lung or pleura.
Failure to cover the mouth and nose when coughing.
Incorrect, lack of, or short duration of anti-tuberculosis
treatment.
Undergoing cough-inducing or aerosol-generating procedures.
Environmental factors that increase the risk for
probability of transmission of M. tuberculosis
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Exposure to TB in small, enclosed spaces.
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Inadequate local or general ventilation that results in insufficient
dilution or removal of infectious droplet nuclei.
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Recirculation of air containing infectious droplet nuclei.
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Inadequate cleaning and disinfection of medical equipment.
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Improper procedures for handling specimens.
Other factors contributing to transmission of
M. tuberculosis in health care setting
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Delayed diagnosis of TB disease.
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Delayed initiation and inadequate airborne precautions.
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Lapses in airborne infection isolation practices and precautions
for cough-inducing and aerosol-generating procedures.
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Lack of adequate respiratory protection.
Prevention of Transmission of Tuberculosis

Risk of transmission of TB in health care facilities from patients with
unrecognized TB.

Patients with signs and symptoms of active infection should be
isolated from general population.

Patient who is admitted is managed in airborne isolation until noninfectious.

Patient wears surgical mask if leaving the room for special
procedures.
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N95 mask worn by HCWs and visitors entering the room.
N95 respirator
Management of tuberculosis in an office setting

Schedule as first or last appointments for the day.

Take patient to exam room as quickly as possible.

Keep patient in exam room until all procedures completed

Seat patient in least crowded area of waiting room.

Enforce cough hygiene; dispose of contaminated tissues in
appropriate containers.

Clean room after patient has left; MTB on environmental surfaces
rarely associated with transmission of TB.

Take care not to alarm other patients.
Responsibilities of Employer
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Hepatitis B vaccine
Provide appropriate personal protective equipment
Readily available safety policies and procedures
Educate staff as appropriate for job description
Provide “safe” sharps as appropriate
Provide PEP as appropriate
Document all employee blood and body fluid exposure
Maintain documentation of employee education
Responsibilities of Employee
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Understand and follow all safety policies and procedures
Use safety equipment properly and appropriately
Participate in appropriate in-services and educational programs
Document education
Report ALL exposures to blood and body fluid in a timely
manner
Maintain good personal hygiene and updated immunizations;
report illnesses as appropriate