TB Exposure Risk

cdc CDC recommends that each healthcare organization establish a TB surveillance program that includes healthcare workers (HCW) “working in healthcare settings who have the potential for exposure to M. tuberculosis through air space shared with persons with infectious TB disease”.

The Occupational Safety and Health Administration (OSHA) TB Policy² states that "employers must comply with the provisions of the following requirements whenever an employee may be occupationally exposed to TB. These requirements are further detailed in two federal government documents:

Section 5 (a)(1) - General Duty Clause and Executive Order 12196, Section 1-201(a) for federal facilities
29 CFR 1910.14 - Respiratory Protection

In keeping with these stipulations, a comprehensive local TB surveillance & training program has been developed fro CAHP personnel. Details are contained within the CAHP - TB Surveillance & Training Program, which spells out student, staff, and faculty training requirements and associated protective work practices.

¹ Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005. Morbidity and Mortality Weekly Report, Vol.54; No. RR17, 30 December 2005. Department of Health & Human Services Centers for Disease Control and Prevention (CDC).
²Overview of Enforcement for Occupational Exposure to Tuberculosis, OSHA PowerPoint Presentation (PPT)

Healthcare Environments

TB exposure risk is now defined by the health-care setting (see Table 1). An at-risk setting includes any area where “HCWs might share air space with persons with TB disease or in which HCWs might be in contact with clinical specimens” [1].It is no longer characterized by facility type since multiple settings may be present in a single facility. Traditional and nontraditional settings are similarly addressed.

Table 1. HCW settings where infectious TB patients may be encountered.

Healthcare Setting	Examples*
Traditional	*Inpatient* - patient rooms, emergency, departments (EDs), intensive care units (ICUs), surgical suites, laboratories, laboratory procedure areas, bronchoscopy suites, sputum induction or inhalation therapy rooms, autopsy suites, and embalming rooms. *Outpatient* - TB treatment facilities, medical offices, ambulatory-care settings, dialysis units, and dental-care settings.
Nontraditional	Emergency medical service ( EMS ), medical settings in correctional facilities (e.g., prisons, jails, and detention centers), homebased health-care and outreach settings, long-term-care settings (e.g., hospice-skilled nursing facilities), and homeless shelters. Other settings in which suspected and confirmed TB patients might be encountered include cafeterias, general stores, kitchens, laundry areas, maintenance shops, pharmacies, and law enforcement settings.

Healthcare Setting

Examples*

Traditional

Inpatient - patient rooms, emergency, departments (EDs), intensive care units (ICUs), surgical suites, laboratories, laboratory procedure areas, bronchoscopy suites, sputum induction or inhalation therapy rooms, autopsy suites, and embalming rooms.

Outpatient - TB treatment facilities, medical offices, ambulatory-care settings, dialysis units, and dental-care settings.

Nontraditional

Emergency medical service ( EMS ), medical settings in correctional facilities (e.g., prisons, jails, and detention centers), homebased health-care and outreach settings, long-term-care settings (e.g., hospice-skilled nursing facilities), and homeless shelters. Other settings in which suspected and confirmed TB patients might be encountered include cafeterias, general stores, kitchens, laundry areas, maintenance shops, pharmacies, and law enforcement settings.

* Extracted from 2005 CDC guidelines [1] and contained within the CAHP - TB Surveillance & Training Program.

At-risk healthcare settings are generally classified as:

low risk (<3 TB patients/year)
medium risk(>3 TB patients/year)
high risk (potential ongoing TB transmission regardless of setting).

Low and medium risk categories for inpatient settings with >200 beds are adjusted upwards to <6 TB patients/year and >6 TB patients/year, respectively.

High-risk category is only a temporary designation and is usually reduced to medium risk when a facility has initiated the appropriate corrective action.

Risk Classification

CAHP personnel are initially classified into one of two exposure risk categories (see Table 2.). TB risk categorization needs only to be accomplished once during employment or student training unless an individual’s exposure-risk changes.

Table 2. TB exposure risk categories

Category	Description
I	Personnel involved in direct face-to-face patient contact or handling clinical samples from those patients with suspect or confirmed TB.*
II	Personnel who do not enter an at-risk TB healthcare setting as part of their student training or employment duties.

* Equally applies to both traditional and nontraditional at-risk TB healthcare settings.

Program participation is not required for Category II personnel. For example, patient/client treatment in a CAHP academic department does not constitute an at-risk setting. Here, the risk of coming into close contact with a TB-infected individual is no greater than that of encountering one in the general population (e.g., supermarket, restaurant, etc).

Responsibilities

Individual charges for all CAHP parties are as follows:

Students & faculty/staff - familiarize him or herself with the elements of this training module & to correctly employ them while functioning in an at-risk environment.
Department Chairpersons - ensure departmental compliance with all TB program components.
Biosafety Committee - assist department chairs, identifies changes in potential TB exposure risk.
Biosafety Officer - Establishes/maintains, reviews, and updates the CAHP TB program.
Dean - overall program administration.

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