Tuberculosis

Counseling continuing education can be earned for this webinar at https://www.allceus.com/member/cart/index/product/id/726/c/

Objectives
~ Learn basic TB facts
~ Differentiate between LTBI and TB
~ Identify signs and symptoms of TB
~ Identify risk factors for TB
~ Learn about TB Prevention Protocols
~ Explore TB & HIV Co-Infection

~ Tuberculosis (TB) is caused by a bacterium called Mycobacterium tuberculosis.
~ The bacteria usually attack the lungs, but TB bacteria can attack any part of the body such as the kidney, spine, and brain.
~ Not everyone infected with TB bacteria becomes sick.
~ latent TB infection (LTBI)
~ TB disease.
~ If not treated properly, TB disease can be fatal.
Latent TB Infection
~ Most people who breathe in TB bacteria and become infected, the body is able to fight the bacteria to stop them from growing.
~ People with latent TB infection:
~ Have no symptoms
~ Don’t feel sick
~ Can’t spread TB bacteria to others
~ Usually have a positive TB skin test reaction or positive TB blood test
~ May develop TB disease if they do not receive treatment for latent TB infection
~ About 5% to 10% of persons with normal immune systems and LTBI will develop TB disease, the risk of is the highest in the first 2 years after infection.

TB Infection (Disease)
~ Has symptoms that may include
~ a bad cough that lasts 3 weeks or longer
~ pain in the chest
~ coughing up blood or sputum
~ weakness or fatigue
~ weight loss
~ no appetite
~ chills
~ fever
~ sweating at night
~ Contagious
How It Is Spread
~ TB bacteria are spread through the air from one person to another. coughs, speaks, or sings.
~ TB is NOT spread by:
~ shaking someone's hand
~ sharing food or drink
~ touching bed linens or toilet seats
~ sharing toothbrushes
~ kissing
~ When a person breathes in TB bacteria, the bacteria can settle in the lungs and move through the blood to other parts of the body, such as the kidney, spine, and brain.
~ TB disease in the lungs or throat can be infectious.
~ TB in other parts of the body, such as the kidney or spine, is usually not infectious.
~ People with TB disease are most likely to spread it to people they spend time with every day.
Risk Factors
~ Persons who have been recently infected with TB bacteria
~ This includes:
~ Close contacts of a person with infectious TB disease
~ Persons who have immigrated from areas of the world with high rates of TB
~ Children less than 5 years of age who have a positive TB test
~ Groups with high rates of TB transmission, such as homeless persons, injection drug users, and persons with HIV infection
~ Persons who work or reside with people who are at high risk for TB in facilities or institutions such as hospitals, homeless shelters, correctional facilities, nursing homes, and residential homes for those with HIV

Risk Factors
~ Persons with medical conditions that weaken the immune system
~ This includes
~ HIV infection (the virus that causes AIDS)
~ Substance abuse
~ Silicosis
~ Diabetes mellitus
~ Severe kidney disease
~ Low body weight
~ Organ transplants
~ Head and neck cancer
~ Medical treatments such as corticosteroids or organ transplant
~ Specialized treatment for rheumatoid arthritis or Crohn’s disease

Non-Infectious
~ 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- to 24-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.

Vaccine
~ BCG vaccination of health care workers should be considered on an individual basis in settings in which
~ A high percentage of TB patients are infected with TB strains resistant to both isoniazid and rifampin;
~ There is ongoing transmission of drug-resistant TB strains to health care workers and subsequent infection is likely; or
~ Comprehensive TB infection-control precautions have been implemented, but have not been successful.
~ Health care workers considered for BCG vaccination should be counseled regarding the risks and benefits associated with both BCG vaccination and treatment of latent TB infection.

TB & HIV CoInfection
~ Without treatment, as with other opportunistic infections, HIV and TB can work together to shorten lifespan.
~ Someone with untreated latent TB infection and HIV infection is much more likely to develop TB disease during his or her lifetime than someone without HIV infection.
~ Among people with latent TB infection, HIV infection is the strongest known risk factor for progressing to TB disease.
~ A person who has both HIV infection and TB disease has an AIDS-defining condition.
Drug Resistant TB
~ Drug-resistant TB can occur when the drugs used to treat TB are misused or mismanaged. Examples of misuse or mismanagement include
~ People do not complete a full course of TB treatment
~ Health care providers prescribe the wrong treatment (the wrong dose or length of time)
~ Drugs for proper treatment are not available
~ Drugs are of poor quality
Drug Resistant TB
~ Drug-resistant TB is more common in people who
~ Do not take their TB drugs regularly
~ Do not take all of their TB drugs
~ Develop TB disease again, after being treated for TB disease in the past
~ Come from areas of the world where drug-resistant TB is common
~ Have spent time with someone known to have drug-resistant TB disease

 

~ People who work or receive care in health care settings are at higher risk for becoming infected with TB
~ TB Infection control programs ensure the following:
~ prompt detection of infectious patients,
~ airborne precautions, and
~ treatment of people who have suspected or confirmed TB disease.
~ The TB infection control program should be based on a three-level hierarchy of control measures and include:
~ Administrative measures
~ Environmental controls
~ Use of respiratory protective equipment

Administrative
~ Assigning someone the responsibility for TB infection control in the health care setting;
~ Conducting a TB risk assessment of the setting;
~ Developing and implementing a written TB infection-control plan;
~ Ensuring the availability of recommended laboratory processing, testing, and reporting of results;
~ Implementing effective work practices for managing patients who may have TB disease;
~ Ensuring proper cleaning, sterilization, or disinfection of equipment that might be contaminated (e.g., endoscopes);
Administrative
~ Educating, training, and counseling health care workers, patients, and visitors about TB infection and TB disease;
~ Testing and evaluating workers who are at risk for exposure to TB disease;
~ Applying epidemiology-based prevention principles, including the use of setting-related TB infection-control data;
~ Using posters and signs to remind patients and staff of proper cough etiquette (covering mouth when coughing) and respiratory hygiene; and
~ Coordinating efforts between local or state health departments and high-risk health-care and congregate settings.

Environmental
~ Primary environmental controls consist of controlling the source of infection by using local exhaust ventilation (e.g., hoods, tents, or booths) and diluting and removing contaminated air by using general ventilation.
~ Secondary environmental controls consist of controlling the airflow to prevent contamination of air in areas adjacent to the source airborne infection isolation (AII) rooms; and cleaning the air by using high efficiency particulate air (HEPA) filtration, or ultraviolet germicidal irradiation.

Respiratory Protective Equipment
~ Implementing a respiratory protection program;
~ Training health care workers on respiratory protection; and
~ Educating patients on respiratory hygiene and the importance of cough etiquette procedures.

Confidentiality
~ because TB is considered a significant threat to the public’s health, the disclosure of patient information from the private health care worker to a designated public health authority without the patient’s permission or authorization is allowed for the purpose of TB control
~ Patient authorization is NOT needed for passive case reporting
~ Passive case reporting is the required reporting of suspected or confirmed TB cases to a public health authority.

 

Summary
~ TB is still a pressing problem
~ HIV, weakening of public health systems and the emergence of drug-resistant TB are making it more difficult to control the disease.
~ TB is spread by air droplets which are inhaled.
~ People with weakened immune systems are at greater risk for TB infection
~ People with normal immune systems may have latent TB infection and should be regularly tested
~ Working in emergency services, substance abuse or criminal justice settings increases exposure risk
~ Health and behavioral health agencies must have an infection control policy which addresses TB