Post Exposure management for contracting TB
Post Exposure management for contracting TB
Working in health care facility as you’re profession and caring of patient infected with various types of pathogen make you at risk of acquiring occupational disease if you are not aware of the proper personal protective equipment you need to use for each disease and / or procedure and immunization by receiving a vaccine for vaccine preventable diseases one of the high risk disease is pulmonary tuberculosis that can lead to infected health care workers by exposure to if unprotected contact with an infected patient. All health care workers that are involved in contacting the patient need to undergo the occupational health assessment for the exposure for our previous topic Management of PTB inside Operative Theater discussing the management of PTB inside OR team need to be informed about post exposure management
We have two elements for the exposure to happen susceptible person and time of communicability in blood-borne viruses we also depend on the virus load_ for a susceptible person: A person who may contract an infection due to lack of immunity. Immunity may follow natural disease or receiving vaccine or specific immunoglobulin. Therefore history of infection, vaccination or laboratory test is necessary to determine susceptibility . Susceptible HCW should be excluded from caring patients with infection to which is susceptible. So the Period of Communicability: the time during which the infected person is in the infectious state and continues shedding of the infective pathogen. Work restrictions of the HCW and/ or isolation precautions should be considered to prevent the spread of infection to others. Occupational exposures should be considered urgent medical concerns to ensure timely post exposure management and avoid any spread of infection to other staff, patients or visitors.
For any health care facility that provide care for such patient it needs to provide a clear program to prevent and control any exposure that target reduction of occupational infections as a primary prevention strategy by providing education and guidance for health care workers about the proper dealing with such cases as a priority for the program then providing a process for managing those infections (training and awareness of the team for the principles of post exposure management , availability of TST/ Mantoux test , availability of medication, trained health care worker for managing such situation , leadership support for implementing …etc.)
To determine risk associated with the exposure (for all infectious diseases including TB) to manage the exposed staff, the potential to infection should be evaluated:(Is the exposed person susceptible or immune, Period of Communicability, Incubation period of the disease, Infectious material, Modes of transmission, Date of exposure, Type(s) & duration of Isolation Precautions required to break the chain of infection, Type(s) of immunization recommended and time of administration for efficient protection)
All team by joining any health care organization need to do tuberculin skin test to measure the baselines measurement for the response and need to be performed annually (by renewal of the contract) plus after TB exposure (4-6 weeks after exposure) to check the response (diameter has to be recorded in Millimeter not only documenting positive or negative for the newly recognized positive tuberculin skin test certain steps need to be initiated (Post Exposure Management) :
Clinical assessment: Any HCW with a newly recognized positive TST result, test conversion, or symptoms or signs of TB disease start to appear immediately clinical evaluated has to be started. The evaluation should be arranged with occupational health clinic / facility staff clinic and the Infection prevention & Control Department. Any physicians who evaluate HCWs with suspected TB disease need to be chest physician or at least should be familiar with current diagnostic and therapeutic guidelines for TB disease. The definitions for positive test results for M. tuberculosis infection and test conversion in HCWs should be known. Symptoms of a disease in the lung, pleura, or airways, and the larynx include coughing for >3 weeks, loss of appetite, unexplained weight loss, night sweats, hemoptysis, hoarseness, fever, fatigue, or chest pain collection of sputum specimens for AFB and culture and sensitivity (the most important mainly because HCWs mainly develop MDR TB & and XDR TB) If TB disease is diagnosed, begin antituberculosis treatment immediately based on the result of sensitivity report.
Chest Radiography: need to be performed as the baseline when the staff joining the health care facility and when HCWs with a positive or newly positive TST result should do chest radiograph to exclude a diagnosis of TB disease After this baseline chest radiograph is performed, and the result is documented, repeat radiographs are not needed unless symptoms or signs of TB disease develop or a clinician recommends a repeat chest radiograph.
Workplace Restrictions: HCWs with confirmed infectious pulmonary — laryngeal, endobroncheal, or tracheal TB disease, or a draining TB skin lesion pose a risk to patients, HCWs, and others as they considered as highly infectiou —. Such HCWs should be excluded from the workplace until:
1) three consecutive sputum samples collected in at least 24-hour that are negative, with at least one sample from an early morning specimen
2) The person has responded to antituberculosis treatment that will probably be effective;
3) The person is determined to be noninfectious by a chest physician
HCWs with extra-pulmonary TB disease usually do not need to be excluded from the workplace as long as no involvement of the respiratory tract has occurred same as the patient with extra-pulmonary TB we are not placing them under AIIR
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