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Healthcare Worker-Related Tuberculosis Exposure
June 2006
E99
4) Scales were cleaned after each use 5) Symptomatic pts were placed in private rooms on contact/respiratory precautions. At the end of 6 weeks, no new cases were identified. Additional interventions included providing hand sanitizer and education to patients and their families regarding hand hygiene and respiratory etiquette; and separating infected and symptomatic patients from non-infected patients during transportation to and from the clinic, in the waiting room, bathrooms and exam areas. Since 7/05, there have been 8 cases of Para 3. RESULTS: Although, stringent IC measures were enforced, the current outpatient facility is in need of renovation to address several infection control concerns. LESSONS LEARNED: It is important to routinely access the treatment modality and status of the pts when evaluating the IC plan. Most importantly, more stringent IC precautions and separation should be considered in both inpatient and outpatient settings. Separate cubicles with barriers, more hand washing sinks, and more bathrooms are needed to prevent transmission of infections in an open common unit such as ABMT.
Publication Number 12-116
Healthcare Worker-Related Tuberculosis Exposure CF Korn, RN, MPH1 BA Burke, RN, MA1 GM Garvin, RN, MEd1 CA Sulis, MD1 1
Hospital Epidemiology, Boston Medical Center, Boston, MA, USA
ISSUE: Boston Medical Center (BMC) is a 547-bed urban teaching hospital. On 6/3/05, the Boston Public Health Commission (BPHC) identified a healthcare worker (HCW) whose sputum was positive for acid fast bacillus (AFB). The HCW was immediately removed from patient care duties and empiric therapy with 4 drugs was initiated. The organism was identified as Mycobacterium tuberculosis on 6/13/05. PROJECT: BPHC determined that the HCW was potentially infectious from 12/1/04 until 6/2/05. During that time, the HCW performed clinical duties at 4 hospitals in MA. In collaboration with the MA Department of Public Health and the Centers for Diseases Control and Prevention, BPHC developed a contact investigation protocol. All institutions used the same exposure definitions and dates to identify potentially exposed patients and HCW. Data from all 4 institutions were entered into a shared database that was managed by BPHC. Within the next 6 weeks, all potentially exposed HCW had mandatory baseline tuberculin skin tests (TST) or symptom screen. Patients were offered free screening. Anyone whose last potential exposure occurred within 3 months of the baseline test was re-screened beginning in September 2005. At BMC, anyone with a positive TST or symptom screen was referred to the on-site Tuberculosis (TB) Clinic for evaluation. RESULTS: As of 12/15/05, 1514 patients, 1482 HCW had been screened at BMC. BPHC identified a small number of potentially exposed patients and HCW who met the definition for TST conversion and had no other identified risk factors. No patient or HCW developed active disease. LESSONS LEARNED: A TB exposure occurred despite having the following systems to prevent transmission of contagious infectious diseases in the workplace. 1. All HCW and students must have a baseline two-step TST upon hire and at least annually thereafter. 2. HCW with a positive TST must have a symptom screen and CXR. 3. HCW with symptoms or positive CXR are removed from patient care until evaluated by a healthcare provider with expertise in TB. 4. HCW must provide documentation of evaluation prior to being cleared for return to work. The ongoing challenge is to identify effective systems to facilitate early identification and treatment of potentially infectious HCW to prevent similar exposures in the future.
E99
4) Scales were cleaned after each use 5) Symptomatic pts were placed in private rooms on contact/respiratory precautions. At the end of 6 weeks, no new cases were identified. Additional interventions included providing hand sanitizer and education to patients and their families regarding hand hygiene and respiratory etiquette; and separating infected and symptomatic patients from non-infected patients during transportation to and from the clinic, in the waiting room, bathrooms and exam areas. Since 7/05, there have been 8 cases of Para 3. RESULTS: Although, stringent IC measures were enforced, the current outpatient facility is in need of renovation to address several infection control concerns. LESSONS LEARNED: It is important to routinely access the treatment modality and status of the pts when evaluating the IC plan. Most importantly, more stringent IC precautions and separation should be considered in both inpatient and outpatient settings. Separate cubicles with barriers, more hand washing sinks, and more bathrooms are needed to prevent transmission of infections in an open common unit such as ABMT.
Publication Number 12-116
Healthcare Worker-Related Tuberculosis Exposure CF Korn, RN, MPH1 BA Burke, RN, MA1 GM Garvin, RN, MEd1 CA Sulis, MD1 1
Hospital Epidemiology, Boston Medical Center, Boston, MA, USA
ISSUE: Boston Medical Center (BMC) is a 547-bed urban teaching hospital. On 6/3/05, the Boston Public Health Commission (BPHC) identified a healthcare worker (HCW) whose sputum was positive for acid fast bacillus (AFB). The HCW was immediately removed from patient care duties and empiric therapy with 4 drugs was initiated. The organism was identified as Mycobacterium tuberculosis on 6/13/05. PROJECT: BPHC determined that the HCW was potentially infectious from 12/1/04 until 6/2/05. During that time, the HCW performed clinical duties at 4 hospitals in MA. In collaboration with the MA Department of Public Health and the Centers for Diseases Control and Prevention, BPHC developed a contact investigation protocol. All institutions used the same exposure definitions and dates to identify potentially exposed patients and HCW. Data from all 4 institutions were entered into a shared database that was managed by BPHC. Within the next 6 weeks, all potentially exposed HCW had mandatory baseline tuberculin skin tests (TST) or symptom screen. Patients were offered free screening. Anyone whose last potential exposure occurred within 3 months of the baseline test was re-screened beginning in September 2005. At BMC, anyone with a positive TST or symptom screen was referred to the on-site Tuberculosis (TB) Clinic for evaluation. RESULTS: As of 12/15/05, 1514 patients, 1482 HCW had been screened at BMC. BPHC identified a small number of potentially exposed patients and HCW who met the definition for TST conversion and had no other identified risk factors. No patient or HCW developed active disease. LESSONS LEARNED: A TB exposure occurred despite having the following systems to prevent transmission of contagious infectious diseases in the workplace. 1. All HCW and students must have a baseline two-step TST upon hire and at least annually thereafter. 2. HCW with a positive TST must have a symptom screen and CXR. 3. HCW with symptoms or positive CXR are removed from patient care until evaluated by a healthcare provider with expertise in TB. 4. HCW must provide documentation of evaluation prior to being cleared for return to work. The ongoing challenge is to identify effective systems to facilitate early identification and treatment of potentially infectious HCW to prevent similar exposures in the future.