TUBERCULOSIS
Tuberculosis used to be the # 1 cause of death in the United States 100 years ago. The medical term back then was "consumption". It was spread by overcrowding in dirty areas. We have come a long way since then, but the bacteria causing TB (mycobacterium tuberculosis) still lurks among us and over 25,000 people in the United States are infected every year. This does not include the numbers of people who exhibit antibodies to the TB bacteria and "convert" on their skin tests (turn positive when have been negative before).
Definition of Tuberculosis – a condition presenting with certain symptoms and a positive respiratory specimen or Acid Fast Bacillus (AFB) smear showing the presence of mycobacterium tuberculosis.
Who is most at risk of developing TB? A person who:
- Has continued close contact with a person who has infectious TB
- Is HIV positive
- Has been infected with TB in the last 2 years
- Is a baby or young child
- Is poor or homeless
- Injects drugs into their veins
- Is an Alcoholic
- Is sick with other diseases that affect their immune system
- Is elderly and especially those who live in a community facility like an Assisted Living Facility
It is very important now to practice infection control measures against TB so that we can get rid of the TB Bacteria
What are the signs of TB?
- A productive cough lasting longer than 2 weeks
- Chest pain
- Coughing up blood
- Fever and chills
- Sweating at night
- Loss of appetite
- Weight loss
- Constant tiredness
How is Tuberculosis spread?
- Coughing
- Speaking
- Sneezing
- Singing
Tests for Tuberculosis:
- The TB skin test- prior to employment and every year. Staff who may actually have a high exposure to patients with TB may be tested every 6 months. You will receive a "Mantoux Test" either in a "one step or two step" mode. A small amount of fluid (a purified protein derivative) is injected on the inside of your forearm and after 72 hours the skin and the area surrounding it is looked at. If at this time the skin is red or has a circle spreading from the injection site, you have had a "positive" reaction to the fluid injected. You will be directed to seek medical advice. Having a positive reaction does not mean you have tuberculosis. If you have a negative test after 72 hours, the 2nd Mantoux test is done within a certain time span from the 1st Mantoux test. This is to ensure that the 1st Mantoux Test did not give a false negative reading. It is very important for people who work in the health care field to be tested every year as having a negative test the previous year does not mean you will not have a negative reaction this year. Getting tested is important for your health and for the health of the patients you take care of and your family. If you have a positive Mantoux Test you may be given anti-TB medication, even if you have no signs of the disease. These anti TB medications must be taken for 6 months and alcoholic beverages can be dangerous if you or your patient are on this medication.
- Chest X-Ray is done after a person has a positive reaction to the Mantoux Test. This is done to make sure you do not have active tuberculosis. Your health practitioner can decide how often you may need to have a chest x-ray. Once you have a positive Mantoux Test you will always have a positive reaction, so you will not take the Mantoux Test again. You must keep proof of the negative chest x-ray after the positive Mantoux so that you can give it to your employer.
- Sputum Tests are ordered if a health practitioner thinks that someone has active TB. These sputum tests are cultured and when looked at can confirm the presence of the TB bacteria and whether the person can infect others.
Once a person is diagnosed with tuberculosis, all 50 states have a reporting mechanism to the local health department. All active Tuberculosis infections must be reported. The local health department investigates all reports and assists all people with active tuberculosis infections to get the medications they need to kill the TB bacteria and teaches the community about tuberculosis. People with active TB infections MUST take anti TB medications as prescribed by their health care practitioners. After about 2 weeks, people are no longer infectious, BUT people need to keep taking their medication as the TB bacteria die very slowly and they must keep on the anti TB medications for months. The best way to prevent the spread of the disease is to take the anti-TB medications.
PERSONAL RESPIRATORY EQUIPMENT
As a health care worker, to protect yourself when you work with patients who have or might have tuberculosis, a personal respirator mask must be worn by you at all times in contact with the patient. A paper mask will NOT protect you as the TB bacteria can get through the weave of the mask.
You are fitted for the personal respirator mask and you must put it on before you enter the patient’s areas. You must wear it the entire time you are with your patient and remove it only after you have left your patient’s area.
HOW YOU CAN HELP TO PREVENT THE SPREAD OF TUBERCULOSIS
- Make sure you keep in mind the symptoms of tuberculosis and keep them in mind for any patient you may have
- Limit the production of infectious droplets by having your patients practice good infection control by:
- Ask your patients to cover their mouth and nose with a tissue when coughing or sneezing and then throw the tissue into the garbage
- Air out the patient’s room if possible. Open a window if it is not too cold
- Taking their anti Tuberculosis medications on time and even after they feel better
- Decontaminate the space where droplets are likely to be produced
- Have your Mantoux Test or chest x-ray on schedule
- Wear your personal respirator mask at all times when you are with a patient who has or might have tuberculosis. Make sure you get fitted for the right size mask
- Let your supervisor know if you think any of your clients are showing any signs of tuberculosis
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