Airborne Pathogens

1. Airborne Pathogens Introduction to Healthcare ALHS 1040

2. What is Tuberculosis? • Tuberculosis is an airborne disease carried on • very small mucous droplets suspended in the air. It is released by an infected person through…. • Talking • Coughing • Breathing • Laughing • Singing

3. Tuberculosis • Caused by the bacteria: Mycobacterium Tuberculosis which can affect any site in the body, most often affecting the lungs. • It can spread from person to person through the air.

4. Tuberculosis • Transmitted by respiratory droplets (droplet nuclei)… • Allows for rapid transmission • Infects greater number of hosts in shorter amount of time. • At one time, was the leading cause of death in the U.S. at the beginning of the 20th century.

5. Types of Exposure Tuberculosis Infection • Also called Latent or Inactive Tuberculosis Tuberculosis Disease • Also called Active Tuberculosis

6. Tuberculosis Infection • Can be present if… • You have the TB organism in your body • You do not look or feel ill • You test positive on a TB Skin Test • Can be treated with… • One drug therapy • The drug therapy usually last 6 months, but may last as long as one year.

7. Tuberculosis Infection • If untreated… • 5% of those infected, develop TB disease within two years. • Another 5% will develop TB disease later in life.

8. Tuberculosis Disease You show signs of illness such as: • Weight loss • Loss of energy • Poor appetite May develop if you do not receive treatment for infection You must receive more than one drug therapy Drug therapy usually last six months to one year. • An individual is considered non infectious after 1-3 weeks of drug therapy, if symptoms improve.

9. TB INFECTION VS. TB DISEASE

10. According to the CDC… • Tuberculosis Facts… • There are 2-3 Million deaths worldwide associated with TB. • More than 1/3 of the world’s population has TB, totaling apx. 1 Billion Individuals

11. Tuberculosis in the U.S. • There are an estimated 10-15 million Americans infected with TB • About 10% of those individuals will develop TB sometime in their life.

12. Tuberculosis in the U.S. • In 1953, the US begins National Tuberculosis reporting. The World Health Organization announces that TB Disease and TB Infection will be eliminated by the year 2010. • Between 1953-1985 the infection rate for TB is 6% • In 1991 the CDC reports an 18% increase since 1985 in the number of people in the US with TB Disease.

13. Reasons Why Tuberculosis Has Re-Emerged… • Inadequate control of the disease in high prevalence areas. • Increase in poverty, substance abuse, poor health status, crowded substandard living conditions. • Growing number of inmates • Growing number of people in homeless shelters.

14. Re-Emergence of Tuberculosis • Growing number of immigrants from foreign countries with high prevalence rates • Growing number of elderly in long-term care facilities. • Growing number of persons with HIV Infection • Decreased funding for public health TB programs.

15. Tuberculosis in the U.S. • Individuals with TB Infection are at a 100 time greater risk of developing TB Disease than the general population. • Center for Disease Control and Prevention (CDC) estimate that 10% to 15% of all TB cases and nearly 30% of all TB individuals 25- 44 years of age are among those who are HIV infected.

16. Tuberculosis Worldwide • Someone in the world is newly infected with TB every second. • Nearly 1% of the world’s population is newly infected with TB each year. • Overall, 1/3 of the world’s population is infected with TB bacillus.

17. Tuberculosis Worldwide • 5-10% of these people (if they are not HIV+) will become sick or infectious during their life. • The chance is many times higher for someone with HIV/AIDS • There are approximately 2 million TB related deaths yearly, worldwide.

18. Tuberculosis Worldwide The World Health Organization estimates that the incidence rates of the TB epidemic peaked in 2005.

19. Pop Quiz ! • What do you think are the Top 10 causes of death worldwide…

20. Pop Quiz Answers • Coronary Artery Disease • Strokes and other Cerebro-vascular Diseases • Lower Respiratory Infections • Chronic Obstructive Pulmonary Disease • Diarrheal Disease • HIV/AIDS • TUBERCULOSIS • Lung Cancers • Road Traffic Incidents • Prematurity and low birth weight

21. What do we NOT know… • How long the TB organism can remain suspended in the air. • How long the TB organism can remain infectious outside the body. • How many TB organisms are needed to cause infection in a person.

22. Tuberculosis facts • An estimated 15 Million people in the United States are infected with mycobacterium tuberculosis, leading to TB disease. • Increased number of TB disease cases causes greater risk of nosocomial transmission. • Healthcare workers & others have repeated, prolonged contact with these persons. • Multiple Drug Resistant strains. • Antibiotics

23. Tuberculosis Facts • Primary infection can remain undetected and the individual may not develop any symptoms of TB. • Usually within 2-10 weeks, an infection can be detected by the TB skin test. • Those with significant skin test reaction but NO symptoms are considered to have TB infection. • They can NOT spread TB, BUT are at risk of developing ACTIVETB. • If not treated, the mycobacteria may overcome the immune system and multiply in the future and cause development of the TB disease.

24. Those with increased risk factors for Tuberculosis… • Chronic Malabsorption Syndromes • HIV • Others with depressed immune systems * Early diagnoses is critical because of a greater risk of transmission. • Diabetes Mellitus • Silicosis • Chronic Renal Disease • Prolonged Steroid Therapy • Post-Gastrectomy • Intestinal Bypass • Some Blood Disorders

25. Tuberculosis Signs & Symptoms • Persistent cough • Fever • Malaise • Night Sweats • Fatigue • Loss of Appetite • Weight Loss • Chest Pain • Hemoptysis

26. Diagnosis & Treatments • TB is suspected in patients with depressed immune systems. • Appropriate precautions should be taken. • Appropriate treatment plan followed. • Only proof is with positive sputum culture • Prompt treatment with Anti TB drugs quickly reduce infectiousness of patient • Treatment with drugs usually lasting between 6-12 months.

27. Treatment for TB Disease • If an individual has the TB disease, they will take several medicines to start their treatment, killing the TB germs in the body. They most common types of TB Diseases are: • Isoniazid (i-so-ni-a-zid) “INH” • Rifampin (ri-fam-pin) • Ethambutol(eth-am-byoo-tol) • Pyrazinamide (peer-a-zin-a-mide)

28. Tuberculosis Treatment • Anti TB Drug (6-12 months) • HIV + persons are treated with 3-4 drug regiment. • Observe patient for non-compliance which is a major problem. • With adequate treatment bacteria will die and patient will recover. • Emergence of drug resistant strains of TB-due to failure to comply with treatment modality.

29. Tuberculosis Treatment tips • If you stop taking medicines for TB disease early or do not take them the right away: • You can become sick again and stay stick for a longer time. • The medicines can stop working and you may have to take different medicines that have more side effects. • Even the new medicines may not work to cure the TB. • You can pass TB germs on to others again.

30. Tuberculosis Treatment question • Q: Once I complete treatment for TB disease and I’m cured, can I get TB again ? A: Yes, but it is not likely. After you take the medicine the right way for as long as your doctor tells you, your chance of getting TB again is low. • Call your doctor right away if you notice any of the signs of symptoms of TB again.

31. Factors that influence transmission of TB Degree of risk for health care workers depends on… • Healthcare setting • Population served • Job category • Health care worker’s immune system Remember, the longer you share the same air without protection, the higher the risk of infection.

32. Factors that influence transmission of TB • For healthcare providers, the risk of transmission includes: • The possibility of coming into contact with someone with TB based on…. • The closeness of the contact • The #of TB bacteria that are released in the air. • Duration of contact • Susceptibility of the healthcare worker who was exposed.

33. Factors that influence transmission of TB Environmental considerations also influence transmission: • Volume of shared air space • Amount of ventilation • Presence or absence of sunlight which kills TB bacteria. • Humidity in room • Crowded condition within the room.

34. Precautions for Tuberculosis • Patient Identified/diagnosed • Placed in isolation, with doors closed at all times. • Rooms should be negative air pressured rooms- air is exhausted to outside, away from intake valves and not re-circulated. • Persons entering room should wear appropriate protective gear and masks.

35. TB Precautions • Patient should be fitted with the appropriate mask, gown, and other protective gear as needed when taken to other areas of the hospital • Ventilation patterns in treatment rooms, ICU, labs, autopsy rooms & ER should meet current guidelines. • Air controls systems • Negative Air Pressure Rooms, HEPA Filters, • HEPA ="High-Efficiency Particulate Air"

36. What is Negative air pressure room? • Air flows INTO the room from the corridor • Air inside the room is changed with a recommendation of 12 x /hour. • Air is exhausted directly to the outside through HEPA filters, making the exhausted air harmless to the outside, • If not exhausted to outside, air must be forced through particulate filters. • Door should always stay closed and room identified as AFB isolation room.

37. CDC Recommendations • Disposable equipment available • Proper disinfection/ sterilization of used equipment • Proper protective gear for health care workers involved with patient • Proper bagging technique & disposal patients waste, lines, biohazard materials, and used equipment & gear. • Strict airborne isolation precautions sused.

38. TB Skin Testing Health Care Personnel-Active Surveillance. • Receive test at time employment • Testing consist of a standard dose of TB protein derivate beneath skin, producing elevation. Examine arm in 48-72 hrs for palpable swelling around injection site. • Interpretation of skin test is based on size of bump (induration) & not redness of the area • Look for bump the size of a pencil eraser or larger-this could mean you have the TB infection. • Negative test should be repeated periodically • After exposure and at intervals thereafter.

39. TB Testing • Positive skin test occurring after history of negative reaction should be considered newly infected with TB bacteria (It does NOT mean that the person has TB disease). • Chest x-ray & preventative therapy are necessary. • No work restriction on person with positive skin test & negative chest x-ray. • DO NOT RETEST A POSITIVE SKIN TEST. • THIS PERSON WILL ALWAYS NEED A CHEST X-RAY

40. Occupational Exposure to Tuberculosis What happens when an employee is exposed to TB at work? • Tuberculosis exposure incident report. • Skin Testing • Medical Evaluation • Indicated Treatments • Special rules for employees/medical rules

41. More about TB skin Testing • All healthcare providers should be tested. • The recommended test is the Monteux PPD Skin Test • PPD=Purified Protein Derivative (Dead TB Bacteria) • Identifies infected persons • Performed by injecting PPD into skin • Examined in 48-72 hours • Results are determined by size of the hard area under skin (induration)---NOT by redness