Text For Citation: 01 Item/Group: 002 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 Tuberculosis (TB) Exposure Control Plan has not been reevaluated since the occurrence of a si gnificant workplace exposure to Mycobacterium tuberculosis. In 2013, at least tw o patients with unrecognized tuberculosis (TB) disease were admitted into the ho spital and cared for by staff, exposing employees to Mycobacterium tuberculosis and subsequently causing 20 employees to contract tuberculosis and exhibit eithe r active or latent forms of the infection. A reevaluation is needed to identify and correct possible problems in TB infection control. 2)Prior to this inspectio n, there was no requirement in Summerlin Hospital Medical Center's Tuberculosis (TB) Exposure Control Plan for annual reevaluations, and the program was not ree valuated on an annual basis. A yearly reevaluation is needed to identify and cor rect possible problems in TB infection control. A feasible and accepted abatemen t method for reducing these hazards, as recommended by the Center for Disease Co ntrol and Prevention (CDC), is to follow their 2005 "Guidelines for the Transmis sion of Mycobacterium tuberculosis in Health Care Facilities" and review the TB infection control plan according to the Guideline' s Evaluation of TB Infection Control Procedures and Identification of Problems s ection. The facility's TB Exposure Control Plan should be revised to reflect the implementation of this. References: 1) Nevada Administrative Code 441A.200: Inf ectious Diseases. List of adopted recommendations, guidelines and publications; review of revision or amendment of adopted recommendation, guideline or publicat ion: The following recommendations, guidelines and publications are adopted by r eference: (h) The recommendations of the Centers for Disease Control and Prevent ion for preventing the transmission of tuberculosis in facilities providing heal th care set forth in "Guidelines for Preventing the Transmission of Mycobacteriu m tuberculosis in Health-Care Settings, 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 Infection-Control Program for Set tings in Which Patients with Suspected or Confirmed TB Disease Are Expected To B e Encountered The TB infection control program should consist of administrative controls, environmental controls, and a respiratory protection program. Every se tting in which services are provided to persons who have suspected or confirmed infectious TB disease, including laboratories and nontraditional facility based settings, should have a TB infection-control plan. The following steps should be taken to establish a TB infection control program in these settings: 2. Develop a written TB infection control plan that outlines a protocol for the prompt recognition and initiation of airborne precautions of persons with suspec ted or con-firmed TB disease, and update it annually. Evaluation of TB Infection Control Procedures and Identification of Problems Annual evaluations of the TB infection control plan are needed to ensure the proper implementation of the pla n and to recognize and correct lapses in infection control. Previous hospital ad missions and outpatient visits of patients with TB disease should be noted befor e the onset of TB symptoms. Medical records of a sample of patients with suspect ed and confirmed TB disease who were treated or examined at the setting should b e reviewed to identify possible problems in TB infection control. The review sho uld be based on the factors listed on the TB Risk Assessment Worksheet (Appendix B). *Time interval from suspicion of TB until initiation of airborne precautions and antituberculosis treatment to: - suspicion of TB disease and patient triage to proper AII room or referral center for settings that do not provide care for pat ients with suspected or confirmed TB disease; - admission until TB disease was s uspected; - admission until medical evaluation for TB disease was performed; - a dmission until specimens for AFB (acid-fast bacilli is a laboratory test that in volves microscopic examination of a stained smear of a patient specimen (usually sputum) to determine if mycobacteria are present) smears and polymerase chain r eaction (PCR)- based nucleic acid amplification (NAA) tests for M. tuberculosis were ordered; - admission until specimens for mycobacterial culture were ordered ; - ordering of AFB smears, NAA tests, and mycobacterial culture until specimens were collected; - collection of specimens until performance and AFB smear results wer e reported; - collection of specimens until performance and culture results were reported; - collection of specimens until species identification was reported; - collection of specimens until drug-susceptibility test results were reported; - admission until airborne precautions were initiated; and - admission until ant ituberculosis treatment was initiated. *Duration of airborne precautions. *Measu rement of meeting criteria for discontinuing airborne precautions. Certain patie nts might be correctly discharged from an AII room to home. *Patient history of previous admission. *Adequacy of antituberculosis treatment regimens. *Adequacy of procedures for collection of follow-up sputum specimens. *Adequacy of dischar ge planning. *Number of visits to outpatient setting from the start of symptoms until TB disease was suspected (for outpatient settings). Work practices related to airborne precautions should be observed to determine i f employers are enforcing all practices, if HCWs are adhering to infection contr ol policies, and if patient adherence to airborne precautions is being enforced. Data from the case reviews and observations in the annual risk assessment shoul d be used to determine the need to modify 1) protocols for identifying and initi ating prompt airborne precautions for patients with suspected or confirmed infec tious TB disease, 2) protocols for patient management, 3) laboratory procedures, or 4) TB training and education programs for HCWs.