Text For Citation: 01 Item/Group: 001 Hazard: TB

Nevada Revised Statute 618.375(1): Duties of employers. Every employer shall fur nish employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his o r her employees: 1)Prior to this inspection, Summerlin Hospital Medical Center's most recent Tuberculosis (TB) Risk Assessment did not include statistical data related to a 2013 significant workplace exposure to Mycobacterium tuberculosis. At least two patients with unrecognized tuberculosis (TB) disease were admitted into the hospital and cared for by staff, exposing employees to Mycobacterium tu berculosis and subsequently causing 20 employees to contract tuberculosis and exhibit either active or latent forms of the infection . A TB Risk Assessment that included this data is necessary so the quality of th e hospital's TB infection control can be properly evaluated, and needed improvem ents in infection control measures can be identified. 2)Since the recent workpla ce exposure to Mycobacterium tuberculosis, Summerlin Hospital Medical Center has not followed its own TB Exposure Control Plan that states a "Risk Evaluation" w ill be conducted in the event of an exposure. Prior to this inspection, Summerli n Hospital Medical Center did not conduct a Tuberculosis (TB) Risk Assessment th at included statistical data related to a 2013 significant workplace exposure to Mycobacterium tuberculosis. A feasible and accepted abatement method for reduci ng these hazards is to follow Summerlin Hospital Medical Center's TB Exposure Co ntrol Plan which requires a Risk Assessment to be conducted in the event of an e xposure. The Assessment should include data regarding the specific exposure. Fur thermore, conducting TB Risk Assessments on an ongoing basis would reduce this hazard, as recommended by the Center for Dise ase Control and Prevention (CDC) in the 2005 "Guidelines for the Transmission of Mycobacterium tuberculosis in Health Care Facilities." The Assessment should be completed following the requirements of the TB Risk Assessment section. Referen ces: 1) Nevada Administrative Code 441A.200: Infectious Diseases. List of adopte d recommendations, guidelines and publications; review of revision or amendment of adopted recommendation, guideline or publication: The following recommendatio ns, guidelines and publications are adopted by reference: (h) The recommendation s of the Centers for Disease Control and Prevention for preventing the transmiss ion of tuberculosis in facilities providing health care set forth in "Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Se ttings, 2005," Morbidity and Mortality Weekly Report[54(RR17):1-141, December 30, 2005]. 2) "Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health Care Facilities," 2005. Centers for Disease Control and Prevention (CDC) , MMWR December 30, 2005/Vol. 54/No. RR-17. TB Risk Assessment for Settings in W hich Patients with Suspected or Confirmed TB Disease Are Expected To Be Encounte red The initial and ongoing risk assessment for these settings should consist of the following steps: 1. Review the community profile of TB disease in collabora tion with the state or local health department. 2. Consult the local or state TB control program to obtain epidemiologic surveillance data necessary to conduct a TB risk assessment for the health-care setting. 3. Review the number of patients with suspected or confirmed TB disease who have been encountered in the setting during at least the previous 5 years. 4. Determine if persons with unrecognized TB disease have been admitted to or we re encountered in the setting during the previous 5 years. 5. Determine which HC Ws need to be included in a TB screening program and the frequency of screening (based on risk classification) (Appendix C). 6. Ensure the prompt recognition an d evaluation of suspected episodes of health- care-associated transmission of M. tuberculosis. 7. Identify areas in the setting with an increased risk for healt h-care-associated transmission of M. tuberculosis, and target them for improved TB infection controls. 8. Assess the number of AII rooms (Formerly called negati ve pressure isolation room, an AII room is a single-occupancy patient-care room used to isolate person s with suspected or confirmed infectious TB disease) needed for the setting. The risk classification for the setting should help to make this determination, dep ending on the number of TB patients examined. At least one AII room is needed fo r settings in which TB patients stay while they are being treated, and additiona l AII rooms might be needed, depending on the magnitude of patient- days of case s of suspected or confirmed TB disease. Additional AII rooms might be considered if options are limited for transferring patients with suspected or confirmed TB disease to other settings with AII rooms. 9. Determine the types of environment al controls needed other than AII rooms (see TB Airborne Precautions). 10. Deter mine which HCWs need to be included in the respiratory protection program. 11. Conduct periodic reassessments (annually, if possible) to ensure 1.- proper implementation of the TB infection control plan, 2.- prompt detection and evalua tion of suspected TB cases, 3.- prompt initiation of airborne precautions of sus pected infectious TB cases, 4.- recommended medical management of patients with suspected or confirmed TB disease (31), 5.- functional environmental controls, 6 .- implementation of the respiratory protection program, and 7.- ongoing HCW tra ining and education regarding TB. 12. Recognize and correct lapses in infection control. TB Screening Risk Classifications -The three TB screening risk classifi cations are low risk, medium risk, and potential ongoing transmission. The class ification of low risk should be applied to settings in which persons with TB dis ease are not expected to be encountered, and, therefore, exposure to M. tubercul osis is unlikely. This classification should also be applied to HCWs who will never be exposed to persons with TB disease or to clini cal specimens that might contain M. tuberculosis. -The classification of medium risk should be applied to settings in which the risk assessment has determined t hat HCWs will or will possibly be exposed to persons with TB disease or to clini cal specimens that might contain M. tuberculosis. -The classification of potenti al ongoing transmission should be temporarily applied to any setting (or group o f HCWs) if evidence suggestive of person to-person (e.g., patient-to- patient, p atient-to-HCW, HCW to-patient, or HCW to-HCW) transmission of M. tuberculosis ha s occurred in the setting during the preceding year. Evidence of person to-perso n transmission of M. tuberculosis includes 1) clusters of TST or BAMT conversion s, 2) HCW with confirmed TB disease, 3) increased rates of TST or BAMT conversio ns, 4) unrecognized TB disease in patients or HCWs, or 5) recognition of an identical strain of M. tuberculosis in patients or HCWs with TB disease id entified by deoxyribonucleic acid (DNA) fingerprinting. If uncertainty exists re garding whether to classify a setting as low risk or medium risk, the setting ty pically should be classified as medium risk. TB Screening Procedures for Setting s (or HCWs) Classified as Potential Ongoing Transmission -Testing for infection with M. tuberculosis might need to be performed every 8-10 weeks until lapses in infection control have been corrected, and no additional evidence of ongoing tr ansmission is apparent. -The classification of potential ongoing transmission sh ould be used as a temporary classification only. It warrants immediate investiga tion and corrective steps. After a determination that ongoing transmission has c eased, the setting should be reclassified as medium risk. Maintaining the classification of medium risk for at least 1 yea r is recommended. 3) Summerlin Hospital Medical Center Policies and Procedures - TB Exposure Control Plan Page 4 D. Initial and Periodic Risk Assessment 3. Risk Evaluation of personnel will be done initially on hire and within every 365 day s hereinafter, or in the event of an exposure.