Infection Prevention and Control – Tuberculosis: Precautions for Care of Patients with
Infectious Pulmonary Mycobactreium TuberculosisSECTION: 14.25
Strength of Evidence Level: 1__RN__LPN/LVN__HHA
PURPOSE:
To protect clinical staff from pulmonary Mycobacterium Tuberculosis (MTB) infection while providing care to patients with infectious MTB.
To provide education to patient and caregivers to decrease transmission of MTB.
CONSIDERATIONS:
- Transmission of MTB has been documented in staff who work in homecare.
2.All clinical staff who are assigned to patients with suspected or confirmed infectious pulmonary MTB will be provided and fitted with a NIOSH approved (at least N95) Respirator Mask for individual, personal protection prior to providing care.
[Note: State OSHA guidelines may supersede federal guidelines.]
3.Clinical staff that cannot be adequately fitted with the NIOSH-approved respirator will not be assigned to these patients. Also, personnel with histories of respiratory problems/compromise should not be assigned to these patients.
4.A maintenance program that includes proper cleaning, inspection, repair and storage of the respirator will be part of the clinical staff instruction at time of fitting.
5.Trained personnel will instruct the clinical staff members on proper respirator use and fit-check in accordance with the manufacturer's instructions and guidelines.
6.Avoid performing cough-inducing or aerosolizing procedures on patients with suspected or confirmed infectious MTB. Sputum collection should be performed outdoors, away from other persons, windows and ventilation intakes.
- Precautions may be discontinued when the patient is improving clinically, cough has decreased, and the number of organisms in the sputum Acid-fast bacillus (AFB) smear has decreased. Discontinuance of protective equipment will be based on physician order and/or documented laboratory studies. Currently, patients are considered non-communicable when they have two negative sputum smears for AFB one week apart or 3 negative sputum smears on consecutive days. Usually this occurs 2 to 3 weeks after tuberculosis medications are begun.
EQUIPMENT:
NIOSH approved respiratory mask, fit-tested
Personal Protective Equipment (PPE) per standard precautions
Impervious trash bags
PROCEDURE:
1.Adhere to Standard Precautions.
- Ask the patient/caregiver to open a window about 30 minutes prior to start of visit.
3.Don and fit check NIOSH-approved respiratory mask when entering the home or patient's room. Don other PPE, per standard precautions
4.Maintain NIOSH approved respiratory mask according to agency training.
5.Educate patient/caregiver in infection control precautions including, but not limited to, the following:
a.Cough etiquette: Patient to cover mouth and nose for coughs and sneezes.
b.Dispose of contaminated tissues immediately into the trash.
c.Perform hand hygiene after handling secretions.
d.Patient is to wear a mask when leaving home and avoid going to crowded places.
6.Educate patient and caregivers about the importance of taking medications as prescribed.
7.Recommend that immune suppressed persons or young children should avoid living in the same home or visiting patient until the patient is considered non-infectious.
AFTER CARE:
1.Document instructions given to patient/caregiver in patient’s record.
2.Unless already done, report TB case to local health department according to agency policy and acceptable regulations.
REFERENCE:
Centers for Disease Control and Prevention. (2005). Guidelines for Preventing Transmission of Mycobacterium Tuberculosis in HealthCare Settings, MMWR;54(No. RR17).