HHC Health & Home Care Clinical Policy And

HHC HEALTH & HOME CARE Section: 13-16
Infection Control: Tuberculosis, Precautions for Care ` __RN
PURPOSE:
To protect clinical staff and caregivers and prevent the
spread of Tuberculosis (TB) while providing care to
patients with Pulmonary Mycobacterium TB.
CONSIDERATIONS:
Note: OSHA enforcement guidelines regarding the use
of the HEPA Respiratory Masks may be revised based
on the 10/28/94 CDC Guidelines for Preventing the
Transmission of Mycobacterium Tuberculosis in Health-
Care facilities. State OSHA guidelines may supercede
Federal guidelines.
1. All clinical staff who are assigned to patients with
suspected or confirmed infectious Pulmonary TB will
be provided and fitted with a NIOSH approved (at
least N95) HEPA (High Efficiency Particulate Air)
Respiratory Mask for individual, personal protection
prior to providing care.
2. Clinical staff that cannot be adequately fitted with
the HEPA respirator will not be assigned to these
patients. Also, personnel with histories of
respiratory problems/compromise should not be
assigned to these patients.
3. 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.
4. Trained personnel will instruct the clinical staff
members on proper respirator use and fit-check, in
accordance with the manufacturer's instructions and
guidelines.
EQUIPMENT:
HEPA respiratory mask, fit-tested
Gloves
Disposable gown
Impervious trash bags
Antimicrobial/non-anti-microbial soap, alcohol-based
hand rubs
PROCEDURE:
1. Adhere to Universal Precautions.
2. Don HEPA respiratory mask when entering the
home or patient's room. Don other personal
protective equipment, as warranted.
3. Maintain HEPA respiratory mask according to
agency training.
4. Dispose of used supplies and equipment. (See
Disposal/Handling of Infectious Medical Waste, No.
14.11.)
5. Clean and disinfect equipment and instruments.
(See Cleaning Equipment and Instruments, No.
14.06 and Disinfection of Equipment and
Instruments Using Disinfecting Agents, No. 14.07.)
6. Instruct patient/caregiver in infection control
precautions including, but not limited to, the
following:
a. Patient to cover mouth and nose for coughs and
sneezes.
b. Dispose of contaminated tissues, napkins,
linens, or receptacles using a double-bag
system. (See Disposal/Handling of Infectious
Medical Waste, No. 14.11.)
c. Wash hands frequently and after handling
secretions.
d. Patient is to wear a mask when leaving home.
e. Recommend that immunosuppressed persons
or young children living in the same home
should be prevented from exposure to the TB
patient or temporarily relocated until the patient
has negative sputum smears.
7. Respiratory precautions may be discontinued when
the patient is improving clinically, cough has
decreased, and the number of organisms in the
sputum 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 sputums smears for AFB one week apart
or three negative sputums on consecutive days.
Usually this occurs 2 to 3 weeks after tuberculosis
medications are begun.
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.
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