Tuberculosis Exposure Control Plan



Important note:TB Control, OHA developed the Tuberculosis Exposure and Control Planas courtesy information for Oregon Local Public Health Authorities.This information does not constitute clinical guidance or policy. LPHAs should modify this document as required to reflect their specific needs and circumstances.Tuberculosis Exposure and Control PlanPurpose:To prevent client, staff and volunteer exposure to Mycobacterium tuberculosis (TB) and ensure compliance with Oregon Occupational Safety and Health Administration (OSHA) standards and CDC guidelines.Contents TOC \o "1-2" \h \z \u I.Assignment of responsibility for TB Exposure and Control Plan (TB ECP) PAGEREF _Toc17975091 \h 3II.Facility Risk Assessment PAGEREF _Toc17975092 \h 3III.TB screening of HCP PAGEREF _Toc17975094 \h 3IV.HCP who test positive for LTBI PAGEREF _Toc17975097 \h 4V.HCP follow-up after TB Exposure PAGEREF _Toc17975098 \h 4VI.Prompt identification of patients who may have TB disease PAGEREF _Toc17975100 \h 4VII.Actions when a patient is suspected of having TB disease PAGEREF _Toc17975101 \h 5VIII.Respiratory Protection Program PAGEREF _Toc17975103 \h 5IX.Respiratory Protection Plan PAGEREF _Toc17975104 \h 6X.Annual TB Education for HCP PAGEREF _Toc17975106 \h 7References PAGEREF _Toc17975107 \h 7Definitions and Acronyms PAGEREF _Toc17975108 \h 8Assignment of responsibility for TB Exposure and Control Plan (TB ECP)ResponsibilityPosition ResponsibleEnsure compliance with TB ECP and report any compliance issues to management Perform annual facility risk assessment and revise TB ECP as neededProvide facility-wide TB education and maintain documentation of HCP attendanceImplement and maintain required documentation of HCP TB screening program* Implement and ensure complete contact investigation if HCP exposure occursAdminister and maintain the Respiratory Protection ProgramMonitor and maintain environmental controls such as HEPA filter units, UV lights or negative pressure rooms*HCP as defined by CDC includes all paid and unpaid persons working in a health care setting who might share air space with an infectious TB patient. This could include volunteers, janitors, managers, etc. See CDC Guidelines for complete list.It is the responsibility of each HCP to know and understand the TB ECP.The TB ECP will be accessible to all HCP by (insert location of the plan)Facility Risk AssessmentAn annual facility risk assessment will be conducted to affirm appropriate procedures are in place and evaluate the risk for transmission of TB within the clinic plete the risk assessment each year using this form:Risk Assessment worksheet (fillable Word doc) (complete sections related to outpatient settings)TB screening of HCP HCP as defined by the CDC includes all paid and unpaid persons working in a health care setting who could potentially share air space with an infectious TB patient. This could include volunteers, janitors, managers, etc. See CDC Guidelines for complete list. The employer is required to provide or pay for any TB testing or chest x-rays needed for employment. Screen all new HCP with patient contact.Screen all new HCP for TB risks upon hire. Consider repeating baseline test when HCP is positive but has no known TB risk factors.Screen all new HCP for TB symptoms upon hire.Evaluate any symptomatic HCP promptly for TB disease. This may include a chest x-ray and sputum collection.Record TST or IGRA results in a confidential employee file.If needed, consult CDC Guidelines or TB Program, OHA if HCP has been recently tested or previously tested positive for LTBI.If an HCP refuses TB testing the policy is to xxxx (insert policy here).HCP who test positive for LTBIAll HCP who have a positive TB skin test or IGRA will be given a CXR.If the CXR is normal and HCP is asymptomatic, HCP will receive education about LTBI and importance of treatment with emphasis on shorter course regimens (e.g. RIF x 4 months or 3HP).HCP will be referred for LTBI treatment or treated by xxxx (insert provider here).HCP follow-up after TB ExposureInitiate a TB contact investigation when HCP not wearing a fit tested N95 respirator or powered air purifying respirator (PAPR) are exposed to either a patient or another employee who has been diagnosed with infectious TB disease. If an exposed HCP had a negative TB test upon hire:Screen HCP for symptoms of TB disease.Screen HCP with a TST or IGRA as soon as possible after the exposure.A TST > 5 mm is a positive test for contacts.If the baseline test was negative, test the HCP again with the same type of test 8-10 weeks after the exposure occurred.If the HCP is immunocompromised, obtain consultation.If the HCP tests positive, obtain a chest x-ray and refer or provide LTBI treatment using a short course regimen.If an exposed HCP had a positive TB test upon hire:Screen the HCP for symptoms of TB disease.If the HCP is immunocompromised, obtain consultation on need for chest x-ray and LTBI treatment.If an HCP is infected with tuberculosis after a known exposure to a case of TB disease, this should be recorded as per OSHA requirements: identification of patients who may have TB diseaseAll staff should know the signs and symptoms of TB and their role in TB infection control.Suspect TB disease and initiate respiratory precautions when the patient:Reports a cough of 3 weeks or more and one of the following symptoms: coughing up blood, night sweats, unexplained weight loss, fever, fatigue and loss of appetite ORHas a positive acid-fast bacilli sputum smearORHas newly started 4-drug treatment for suspected TB diseaseActions when a patient is suspected of having TB diseaseIsolate patient from staff and other patients. Patient will be isolated by (insert designated isolation room or other plan for isolation).Place a sign on the door of the designated isolation room alerting others to not enter without appropriate personal protective equipment (example of signage: “Patient under respiratory precautions. N95 mask required to enter.”). The room will remain closed with the sign in place for xxxx hours after the patient has departed. Signs for this purpose are kept at xxxxx (specify location).Patient will wear a surgical mask as tolerated. Also give patient tissues to cover their mouth and nose along with a receptacle for disposal.Staff will wear the appropriate fit tested respirator (N95 mask) or PAPR as provided by xxxx (specify health department).Schedule potentially infectious patients at the end of the day if possible. Alternatives to clinic visits include meeting the patient outside or at their home.If patient must be transferred to another facility for care (such as chest X-ray) notify the facility in advance that the patient is suspected to have TB.Respiratory Protection ProgramThe respiratory protection program is required by OSHA. Check the NIOSH website for more details and training videos on all topics below. HCP are required to wear NIOSH certified N-95 respirators or PAPRs when:In the presence of a probable or confirmed infectious TB patient.Entering a room which has been occupied by a probable or confirmed infectious TB patient prior to the time required for 99% of airborne contaminates to be removed from room.Transporting a person with probable or confirmed infectious TB patient in an enclosed vehicle.Required documents for the program will be maintained by: xxxx (specify responsible party). We have selected the following (insert brand and model and the sizes available) of respirators for use.Respiratory Protection PlanThe respiratory protection plan consists of the following components:Medical evaluation of the HCP’s ability to wear a respirator (N95 mask)A licensed health care professional should perform a medical evaluation using a questionnaire to determine whether or not the HCP is physically able to wear a respiratorAdminister the questionnaire confidentiallyThe employer shall ensure a follow-up medical examination is provided for any HCP who gives a positive answer on the questionnaire that indicates a medical exam is neededIf the HCP is unable to wear a respirator due to a medical condition, provide the HCP with a powered air purifying respirator (PAPR) or assign to an area where respirator use is not neededFit testing of the HCP for the respirator (N95 mask)Perform fit testing upon hire and annually thereafter. Document resultsPerform fit testing utilizing the respirator issued by the LPHA. The respirator brand/model/size currently used is: _________.Conduct either qualitative or quantitative fit testing. Qualitative fit testing is a pass/fail test method using taste, smell, or reaction to an irritant to detect leakage into the respirator face piece. Quantitative fit testing uses a machine to measure the actual amount of leakage into the face piece. Whichever type is used, follow the manufacturer instructions for conducting the test.An HCP with facial hair cannot be fit tested to wear an N95 respirator because facial hair causes a break in the seal.HCP who cannot be fit tested should use a PAPR or be given an alternate work assignment. Education about the use and care of respiratorEducate HCP who are required to use respirators about: selecting an appropriate respirator, inspecting the respirator, fit testing, fit checking and maintaining the respirator.Fit checking should occur each time the respirator is worn to ensure the respirator is appropriately sealed to the face. The method for conducting the test can be found on the box or individual respirator packaging.The respirator may be re-used as long as it isn’t soiled or torn and the fit check is successful.Annual TB Education for HCPHCP will be provided with annual education about tuberculosis. Attendance/completion should be documented and records showing attendance/completion should be maintained. The education will include the following topics.Location of the TB ECPThe symptoms of TB and how it’s spread Appropriate triage of patients with signs and symptoms of TBReview of respiratory protectionThe difference between TB disease and latent TB infectionTB skin testing and IGRAs (QuantiFERON, T Spot)Employer responsibilities in TB Control HCP responsibilities in TB ControlReview of TB risk factors (e.g. in a country with a high rate of TB for >1 month) and importance of getting tested for LTBI if a new risk factor is identifiedA self-assessment for symptoms of TB disease and reminder to report symptoms of TB diseaseEducation about the importance of LTBI treatment and short course regimensReferencesCenters for Disease Control and Prevention. Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings,2005. MMWR 2005;54 (No. RR-17). Tuberculosis Screening, Testing, and Treatment of U.S. Health Care Personnel: Recommendations from the National Tuberculosis Controllers Association and CDC, 2019. MMWR May 17, 2019 / 68(19);439–443 icon Curry International TB Center. Tuberculosis in Infection Control: A Practical Manual for Preventing TB. 2007. OSHA and AcronymsHCP – health care personnel A healthcare worker as defined by CDC includes all paid and unpaid persons working in a health care setting who could potentially share air space with an infectious TB patient. This could include volunteers, janitors, managers, etc. See CDC Guidelines for complete list.IGRA – interferon gamma release assayA blood test for latent TB infection. Includes QuantiFERON?-TB Gold In-Tube test (QFT-GIT) and T-SPOT? TB test LPHA – local public health authorityLTBI – latent TB infectionOHA – Oregon Health AuthorityOSHA – Occupational Safety and Health AdministrationPAPR – powered air purifying respiratorRespirator equipped with a face piece, hood, or helmet, breathing tube, air-purifying filter, cartridge and/or canister, and fan. Air is pulled through the air-purifying element and pushed through the breathing tube and into the face piece, hood, or helmet.TB ECP – Tuberculosis Exposure and Control PlanTB – Mycobacterium tuberculosis ................
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