Emergency Department » Tuberculosis

Tuberculosis (TB) is caused by a bacterium called Mycobacterium tuberculosis. The bacteria usually attack the lungs, but TB bacteria can attack any part of the body such as the kidney, spine, and brain. Generally, persons at high risk for developing TB disease fall into two categories:

  • Persons with medical conditions that weaken the immune system, and
  • Persons who have been recently infected with TB bacteria. This group includes persons who work or reside with people who are at high risk for TB in facilities or institutions such as hospitals, homeless shelters, correctional facilities, nursing homes, and residential homes for those with HIV.

Hazard

Exposure to tuberculosis and other infectious agents from patients in waiting room and treatment areas. Staff may be treating an emergency and be unaware of other pre-existing infectious conditions.

Recognized Controls and Work Practices

The CDC discusses three types of controls for TB infection in healthcare settings:

  1. Administrative controls to minimize the number of areas where exposure to TB can occur
  2. Environmental controls to reduce the concentration of TB
  3. The use of respiratory protection in situations that pose a high risk for exposure

Recognized controls and work practices include:

  • Providing and practicing early patient screening in the ED to identify potentially infectious patients, and provide isolation to prevent employee exposures. Consistent with CDC guidelines, "a diagnosis of respiratory TB disease should be considered for any patient with symptoms or signs of infection in the lung, pleura, or airways (including larynx), including coughing for ≥3 weeks, loss of appetite, unexplained weight loss, night sweats, bloody sputum or hemoptysis, hoarseness, fever, fatigue, or chest pain."
  • Providing an area in the ED that is ventilated separately for TB patients (i.e., patients with suspected or confirmed TB) in facilities in which TB patients are frequently treated. If this is not possible, ensuring that TB patients wear surgical masks, stay in the ED the minimum amount of time possible, and be transferred promptly to isolation rooms.
  • Healthcare facilities serving populations that have a high prevalence of TB may need to supplement the general ventilation or use additional engineering controls in general-use areas where TB patients are likely to go (e.g., waiting-room areas, emergency departments, and radiology suites). These engineering controls include:
    • A single-pass, non-recirculating system that exhausts air directly to the outside.
    • A recirculation system that passes air through HEPA (High Efficiency Particulate Air) filters before re-circulating it to the general ventilation system.
  • Providing worker education, informational materials, and training about TB relevant to employees' work (e.g., symptoms, transmission, controls, and post-exposure protocols), as well as training specifically required by OSHA standards, as applicable. For more information see OSHA Directive CPL 02-02-078.

Requirements under OSHA's Respiratory Protection Standard, 29 CFR 1910.134

Other OSHA standards that may be applicable

  • Post a warning sign outside the ED respiratory isolation room to prevent accidental entry. [29 CFR 1910.145(a)(1)] 29 CFR 1910.145(e)(4) requires that a biological hazard warning shall be used to signify the actual or potential presence of a biohazard and to identify equipment, containers, rooms, materials, experimental animals, or combinations thereof, which contain, or are contaminated with, viable hazardous agents.

Additional Information