Text For Citation: 01 Item/Group: 004 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: Prior to this inspection, Summerlin Hospital Medical Center's T uberculosis (TB) Control Plan did not require prompt evaluations for all employe es whose TB screening tests converted from negative to positive after exposure t o M. tuberculosis. In 2013, at least two patients with unrecognized tuberculosis 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 ex hibit either active or latent forms of the infection. At least eight hospital em ployees who had converted as a result of this workplace exposure had to wait sev en days or longer to receive a chest x-ray to rule out active tuberculosis. A fe asible and accepted abatement method for reducing this hazard, as recommended by the Center for Disease Control and Prevention (CDC), is to follow their 2005 "G uidelines for the Transmission of Mycobacterium tuberculosis in Health Care Faci lities" and promptly evaluate employees who converted to a positive tuberculosis screening test result with a chest radiograph. The facility's TB Exposure Contr ol Plan should be revised to reflect the implementation of this. References: 1) Nevada Administrative Code 441A.200: Infectious Diseases. List of adopted rec ommendations, guidelines and publications; review of revision or amendment of ad opted recommendation, guideline or publication: The following recommendations, g uidelines and publications are adopted by reference: (h) The recommendations of the Centers for Disease Control and Prevention for preventing the transmission o f tuberculosis in facilities providing health care set forth in "Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Setting s, 2005," Morbidity and Mortality Weekly Report[54(RR17):1-141, December 30, 200 5]. 2) "Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health Care Facilities," 2005. Centers for Disease Control and Prevention (C DC), MMWR December 30, 2005/Vol. 54/No. RR-17. Investigating Conversions in Test Results for M. tuberculosis Infection in HCWs: Known Source in the Health-Care Setting An investigation of a test conversion s hould be performed in collaboration with the local or state health department. I f a conversion in an HCW is detected and the HCW's history does not document exp osure outside the health-care setting but does identify a probable source in the setting, the following steps should be taken: 1) identify and evaluate close co ntacts of the suspected source case, including other patients and visitors; 2) d etermine possible reasons for the exposure; 3) implement interventions to correc t the lapse(s) in infection control; and 4) immediately screen HCWs and patients if they were closecontacts to the source case. For exposed HCWs and patients in a setting that has chosen to screen for infection with M. tuberculosis by using the TST, the following steps should be taken: - administer a symptom screen; - administer a TST to those who had previously ne gative TST results; baseline two-step TST should not be performed in contact inv estigations; - repeat the TST and symptom screen 8-10 weeks after the end of exp osure, if the initial TST result is negative (33); o administer a symptom screen , if the baseline TST result is positive; - promptly evaluate (including a chest radiograph) the exposed person for TB disease, if the symptom screen or the ini tial or 8-10-week follow-up TST result is positive; and - conduct additional med ical and diagnostic evaluation (which includes a judgment about the extent of ex posure) for LTBI, if TB disease is excluded.