TB Exposure and Knowledge

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VentMedic

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Yet another TB exposure that makes headlines.

How well did your school prepare you for various infectious diseases including TB?

How often do you get a refresher about TB, Hep C and HIV?

How often are you tested for TB? At the beginning of EMT(P) school? At the time of hire? Yearly? Semi-annually?

Have you "converted" to test positive for TB?

Do you know the difference between latent and active TB?

Have you taken the BCG vaccine?

Do you carry Respirators or N-95 masks? Do you wear them when a patient has symptoms of TB or other possible infectious diseases that are airborne like varicella or measles? At least surgical masks for droplet precautions for pertussis (whooping cough) and meningococcal meningitis? Or, do you wait for the hospital to tell you the patient has an infection that requires the mask such as on an IFT?

Hundreds Exposed to Tuberculosis at 3 Chicago Hospitals

http://www.emsresponder.com/article/article.jsp?id=9328&siteSection=1

Apr. 11--A Northwestern University doctor-in-training potentially exposed hundreds of patients, including infants, at three Chicago-area hospitals to tuberculosis in what is being called an unusual case of a medical-care provider putting patients' health at risk.

The 26-year-old female pediatric resident was diagnosed Tuesday with TB at Northwestern Memorial Hospital in Chicago after experiencing symptoms consistent with the infectious disease, hospitals and the Chicago Department of Public Health said. Symptoms of "active" TB include coughing, night sweats, fever, chills and weight loss.

As of Friday evening, no patients or workers related to this case had been diagnosed with TB. The three hospitals -- Northwestern, Children's Memorial and Evanston -- said they believe the risk to patients is "minimal" from the resident, whose identity was not released. However, hospitals are continuing to notify patients Friday who may have been exposed to the resident over the past 10 months.
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My school didn't prepare me at all for TB. They covered it quickly.

No I haven't converted, I have had two false positives that resulted in chest x-rays.

We are tested yearly.

Yes I know the difference between latent TB and active TB. I tend to stay current on any transmittable disease that has the ability to take my life.

We carry n95's and we are fit tested every year when we have our PPD's.

No I haven't been given the BCG vaccine, I have had the hep b vaccine.

No I dont wait for anyone to tell me anything if I suspect TB we wear masks the hospital gets a phone call of my suspicion of what we are coming in with. If it isn't thats fine. If it is we are protected.
 
My area is poverty stricken and TB is actually common. I am exposed usually at least once every 3 months. So as to testing, tested very often.
 
In class, TB was glossed over like HIV/AIDS. Quite literally we were told "I'm supposed to show you the slides, so here, I'm showing you the slides" and clicked through them too quick to even begin to read. We were required to get tested before entrance into the EMT program and then expected to test twice a year, but that was never followed up on, and I know personally I didn't test twice a year and my classmates probably didn't either.

When I worked at an ambulance service, orientation did actually include a short informative segment on TB, but that was really it. We did carry N-95 masks, but I have never seen or used one during patient contact except for once with an IFT patient and the entire time I worked there I never saw my "fitted" size of N-95 in the supply room.

I've never thought much about TB, having not run into a great amount of patients with TB symptoms, but now that you've posted this thread it has prompted me to do some reading on TB, thank you for posting!
 
YES!!! Excellent!!

BCG is not very good for cooler climates, and even less so for adults. HOWEVER, they are working on a newer version which is much better.
MENINGIOCOCCAL MENINGITIS! Very good point. IF you survive the DIC etc., you can be seriously messed up for the rest of your life, and disfigured at least. Get the shots! Use your masks! Vent fresh air through your unit, wash your hands, and CLEAN things with CLEAN tools/rags and effective, not magc, disinfectants!
Oh, and, PS: never rely 100% upon immunization to keep you well. Like using both a raincoat and an umbrella, you still should not try to walk on water.
 
Somebody tell me about this bcg vaccine. Any vaccine I can get I want it!

I always test positive for tb and as a result am skipping the test and going straight for the xray. I was told that frequent false positive testing can result in an infection, don't know if this is true, hence just going for the chest xray now.

I'm starting EMT class on May 4th but have been a CNA (private duty) for the last 5 years. When I recently took the Rescue CPR class with my instructor he didn't seem to minimize the risk of HIV, Hep B, or TB.

Anyway, I got my books three weeks ago and am already half way through, so if anything appears to be important to me I have been taking notes for further questioning of the teacher during class. I just know I'm going to be one of those pains in the *** (always wanting to know why this or why that).

So back to my first question, tell me about the BCG vaccine please*
 
The infection control supervisor at our local hospital has been wonderful at providing a fairly intense class on what pathogens are out there and in what numbers. We have a lot of TB in our area but not nearly as much TB as MRSA and HepC.

I do not get a false positive on my TB but I am allergic to the skin test. I still have a visible, raised scar as a result of my last TB skin test taken over 10 years ago. I was instructed by my doctor to never get another one. The hospital where I worked gave me a chest x-ray and according to our infection control guru, I don't need to get another x-ray unless there is a suspected exposure or symptoms.

My brother gets a false positive on his tests. He was told by his doctor that this can happen if you were exposed, perhaps in childhood but never developed the disease.


We do have the masks and use them. We have small bags in each rig with a full set of PPE including gowns, face shields, masks, filters for the respirators, gloves. We have had to use them a time or two. Most recently when treating three people for exposure to unknown toxins from a possible meth lab.
 
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TB stands for Tubercle bacillus and is caused by Mycobacterium tuberculosis.
It is a slow growing, wax-coated acid-fast bacterium that can remain viable in dried aerosol droplets for eight months. Although not considered highly infectious, it takes few M. tuberculosis bacteria to start a disease process that can destroy lung tissue, disseminate and result in death.

There is a good chance you have walked by or stood in line at the grocery store with more people who have active TB than you have had in your ambulance. However, when around someone who is coughing forcefully or you are giving an aerosolized medication (Albuterol) in a closed area or close contact be mindful of airborne and droplet precautions. There are also other bacteria and viruses that can create just as many problems as TB.

If your skin test presents as positive it could be:

1. Active TB

2. Latent TB

3. False Positive could be caused by:
a. BCG vaccination
b. Infection with Nontuberculous Mycobacteria


Latent tuberculosis is the term used for people who test positive for tuberculosis (most commonly with a positive tuberculin skin test), but do not have any evidence of active infection.

Tuberculosis is transmitted through airborne spread of Mycobacterium tuberculosis. When a person with active pulmonary TB coughs, aerosolized droplets containing bacilli can invade the lungs of close contacts. In 90-95% of cases, the infected person's immune system halts growth of the bacteria and active disease does not develop, although skin or serological testing for TB will convert to positive. Once positive, a person's TB test will generally remain positive for life.

If a person tests positive, a physician will assess risk factors by the size of the induration of the skin test, CXR and the person's health risks. Treatment with a 6 - 9 month course of medications may be considered. Latent TB infection (LTBI) can become active later with changes in the person's immune systme.

CDC TB questions and answers:
http://www.cdc.gov/tb/faqs/default.htm

The links on the left side of the screen provides many educational sources.
 
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VentMedic said:
Yet another TB exposure that makes headlines.

How well did your school prepare you for various infectious diseases including TB?

How often do you get a refresher about TB, Hep C and HIV?

How often are you tested for TB? At the beginning of EMT(P) school? At the time of hire? Yearly? Semi-annually?

Have you "converted" to test positive for TB?

Do you know the difference between latent and active TB?

Have you taken the BCG vaccine?

Do you carry Respirators or N-95 masks? Do you wear them when a patient has symptoms of TB or other possible infectious diseases that are airborne like varicella or measles? At least surgical masks for droplet precautions for pertussis (whooping cough) and meningococcal meningitis? Or, do you wait for the hospital to tell you the patient has an infection that requires the mask such as on an IFT?

Hundreds Exposed to Tuberculosis at 3 Chicago Hospitals

http://www.emsresponder.com/article/article.jsp?id=9328&siteSection=1
Click to expand...

Yet another reason I recommended general microbiology and pathogenic microbiology for gen eds. It is a very important subject in health care, that is glossed over too much in medic school (yet another one eh?)
 
My class basically glossed over TB with other infection diseases. We are required to take a Blood Bourne class every year to "keep up to date".

I belong to 2 organizations & am tested for TB at least twice every year.

No, I've never converted, but I know people who have.

Yes, I know the difference.

No one has even mentioned the use of the BCG vaccine to us. I have been vaccinated against Hep A & B, & meningitis.

We carry various sized N95 masks on each of our ambulances & we are fit test every year. I would never wait for someone to suggest that we should have put one on a patient or ourselves.
 
We got tested before and after our clinicals. TB is pretty prominent in this area so it was stressed in our class, which makes sense.
 
VentMedic said:
Yet another TB exposure that makes headlines.

How well did your school prepare you for various infectious diseases including TB?
How often do you get a refresher about TB, Hep C and HIV?
Click to expand...
EMT school? I don't remember covering them at all. Doesn't mean it didn't happen, but I don't remember it.

We covered TB and Hep C (well, Hep A, B, C, and lightly covered D and E) in Intro to Human Pathology in my MS program. I've seen AIDs/HIV enough in high school bio and undergrad bio that I feel comfortable in my knowledge of it's pathology and transmission.
How often are you tested for TB? At the beginning of EMT(P) school? At the time of hire? Yearly? Semi-annually?
Click to expand...
For EMS? Never. Required yearly testing when I was volunteering in the hospital and doing clinical research during my undergrad.
Have you "converted" to test positive for TB?
Click to expand...
No.
Do you know the difference between latent and active TB?
Click to expand...
Yes.
Have you taken the BCG vaccine?
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No. Quick question though. Is the benefit of the BCG vaccine worth the cost of extra radiation exposure since you'll test positive on the PPD test, thus requiring a CXR every 3 (or is it 5) years?

Do you carry Respirators or N-95 masks? Do you wear them when a patient has symptoms of TB or other possible infectious diseases that are airborne like varicella or measles? At least surgical masks for droplet precautions for pertussis (whooping cough) and meningococcal meningitis? Or, do you wait for the hospital to tell you the patient has an infection that requires the mask such as on an IFT?
Click to expand...
I put on a surgical mask for any patient with a productive cough. We carry small N-95s (I should probably push to get large on the ambulances as well) and surgical masks.
 
CAOX3 said:
No I haven't converted, I have had two false positives that resulted in chest x-rays.
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Since the PPD test tests for a cell mediated immune response, I'm curious on how you can have a false positive. Either you've been exposed to TB antigens (for example, by the vaccine) or you haven't. It's not a test for active TB.
 
I received BCG (most children born in USSR/Russia do). When I came to US, my tuberculin test was positive (either because of BCG or because I have actually been exposed at some point) and I got treatment for LTBI. Probably wasn't the best option considering BCG.
 
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