CLINICAL LAB SCIENEC

144
ESSENTIALS OF CLINICAL LABORATORY SCIENCE
Infection Control Alert
Workplaces with Potential
for Exposure to TB
CDC ‘s “Guidelines for Preventing the
Transmission of Tuberculosis in Health
Care Settings, With Special Focus on
HIV-Related Issues” are expanded to
cover other high-density population
facilities:
1. Health care facilities, such as
hospitals and clinics
2. Rehabilitation facilities for
posthospitalization, etc.
3. Correctional facilities
4. Homeless shelters and batteredspouse
facilities
5. Long-term health facilities such as
nursing homes
6. Drug treatment centers
7. Any other facility where groups of
people are congregated in close
contact with each other. Travelers
to parts of the world where TB is
endemic often contract the disease if
proper precautions are not observed.
8. Areas where large numbers of
refugees and immigrants from lesserdeveloped
countries have resulted in
increases in the rate of TB, including
cases caused by drug-resistant TB
organisms
room, and full protective gear will be worn. Removal of wastes
from the room requires special handling.
Workers Most at Risk for Occupational Exposure
One of the greatest and most unexpected risks of contracting TB
occurs when both clerical and medical personnel are performing
admitting procedures. When the patient has not yet been diagnosed
with TB nor is even suspected of having TB, the clerical
worker takes no precautions for personal protection. All medical
workers or persons with both direct or indirect patient care and
even those with responsibilities not directly related to medical
procedures but who perform activities that merely place the person
in close proximity to an infected person are considered to be
at risk for contracting TB. As patients from all walks of life and
with various ailments come into health care facilities, any possible
contagious infection will eventually present itself.
A number of categories of health care workers, including
physicians, nurses, physician ’s assistants , respiratory therapists,
radiography technologists, laboratory workers , morgue workers
, emergency medical services personnel, corrections personnel ,
students, and medical course instructors, are most at risk (CDC,
1993, 2005). A physical examination of students entering medical
laboratory science programs is required, and the student will
be tested for a previous exposure or disease conditions as a preexposure
requirement. If the worker, student, or faculty member
previously showed a positive reaction to the TB organism, determination
must be made by radiograph that the person is no longer
contagious and likely to transmit the organism to patients or
coworkers. The person with a positive PPD skin test must have
completed adequate therapy before assuming duties in a medical
treatment facility and must provide appropriate documentation
of having met these requirements. Some countries vaccinate
their citizens with a Bacillus Calmette-Guérin (BCG ) organism
that supposedly provides protection against TB, although there
is some doubt that this mode of immunization is effective. Those
who have been “immunized” in some countries against TB by BCG will always
show a positive result for the PPD; this is not a true positive, since the immunization
itself leads to a positive result, and not contraction of the organism causing
TB. It may be determined that a chest radiograph is also necessary at this time.
First-Time Positive Reaction to PPD (TB Skin Test)
A covered medical worker , faculty member, or student who shows a first-time
positive reaction to the skin test must receive medical clearance by a physician
before further contact with patients or coworkers. This clearance must be in
writing and filed appropriately as required by the medical facility or educational
institution. Personnel found to have active TB disease should also be offered HIV
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