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SOP Number: 19.002
Review Date: Jan 15, 2003
The United States Department of Labor has determined that occupational exposure to tuberculosis is a significant heath problem that requires employer action. Recently drug resistant strains of Mycobacterium Tuberculosis (TB) have become a serious concern and cases of multi-drug resistant tuberculosis (MDR-TB) have occurred in forty states. Mycobacterium Tuberculosis is carried through the air in infectious droplet nuclei of 1 to 5 microns in size. These droplet nuclei may be generated when a person with infectious TB disease coughs, speaks, sings, or spits. In an occupational setting, workers in close contact with persons with infectious tuberculosis disease are at risk of infection with TB. Certain high hazard medical procedures, which are cough inducing, may further increase the risk of infection in health care workers.
(Taken from Directorate of Compliance Programs Memorandum to Regional Administrators U.S. Department of Labor.)
The Student Health Facility at the State University of New York College at Plattsburgh is an outpatient facility offering medical services to a campus of more than five thousand students. It can be reasonably anticipated that the medical staff of this facility will at sometime come into contact with a patient or patients that test positive for Tuberculosis. This document contains procedure guidelines and policies established to protect the Health Care Workers of the College.
The known incidents of tuberculosis is higher in blacks, Asians and Pacific Islanders, American Indians and Alaskan Natives, Hispanics, current or past prison inmates, alcoholics, intravenous drug users, and persons living in the same household as members of these groups.
Mycobacterium Tuberculosis is carried in airborne particles called drop nuclei. These particles are generated when infected persons, speak, cough, sneeze or spit. Due to the small size of the particles (1-5 Microns) they remain airborne and can spread throughout the area. Infection occurs when a susceptible person breathes in the droplet nuclei and bacilli become established on the alveoli of the lungs from where it is spread to the rest of the body.
The Centers for Disease Control recommends that the following specific actions be taken to reduce the risk of tuberculosis transmission:
"A diagnosis of tuberculosis should be considered for any patient with persistent cough or other symptoms compatible with tuberculosis, such as weight loss, anorexia, or fever." Diagnostic measures for tuberculosis should be instituted on these patients. The Clinton County Health Department should be notified of all known or suspected cases immediately.
Designated members of the medical staff who will deal with suspected or known infected patients will be supplied with HEPA (high efficiency particulate air) filter respirators. The standard negative air respirator used is the 3M half Mask. These respirators will be fit tested every 6 months in accordance with the SUNY Plattsburgh Respiratory Protection Plan.
The standard powered air-purifying respirator used is the Racal Power Flow with HEPA filters. All respirator used will be cleaned and disinfected after each use. They must be stored in a clean, dry area and kept ready for immediate use. The health care providers must use these respirators when a known or suspected tuberculosis patient is being examined.
If a known or suspected tuberculosis patient must be transported, it can be done by an ambulance only. The caller will inform the dispatcher if the patient is or is not suspected of being tuberculosis positive.
The Centers for Disease Control recommend the following guidelines for cleaning, disinfecting, or sterilizing patient care equipment:
All members of the medical staff designated for respiratory protection must have a Doctors Clearance on file in the Environmental Health Office stating that they have no condition which would preclude them from working while wearing a respirator. This clearance must be renewed annually.
In addition, preplacement evaluation, administration and interpretation of TB Mantoux skin tests, and periodic evaluations shall be offered to the health care personnel (at not cost to the employee) as follows:
An initial baseline screening at the time of employment; annually for all health care staff; re-testing every six months for workers with exposure. A past history of positive skin testing one of the following course of actions:
Employee exposure to TB will be recorded and kept on file in the Environmental Health Office along with:
TB infections (positive TB Mantoux skin test) and TB disease are both recordable on the OSHA 200 log in the health care setting. If an employee's TB infection, which has been entered on the OSHA 200 log, progresses to TB disease during the five-year maintenance period, the original entry for the infection will be updated to reflect the new information.
Cathleen Eldridge, Associate Director
Office: Sibley Hall 421