Text For Citation: 01 Item/Group: 005 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)Summerlin Hospital Medical Center does not conduct proper diagnostic measures for patients who display signs of tuberculosis (TB). In 2013, at least two patie nts with unrecognized TB disease were admitted into the hospital and cared for b y hospital staff, one of whom displayed signs of tuberculosis, presenting with m iliary TB with pulmonary involvement, but a sputum examination was never conduct ed. Employees were exposed to Mycobacterium tuberculosis, subsequently causing 2 0 employees to contract tuberculosis and exhibit either active or latent forms o f the infection. 2)Prior to this inspection, Summerlin Hospital Medical Center's TB Exposure Control Plan did not include all the significant symptoms that are indicative of a tuberculosis diagnosis, nor did it require the administration of subsequent diagnostic measures, such as a sputum culture, in the presence of th ese symptoms. A feasible and accepted abatement method for reducing these hazard s, as recommended by the Center for Disease Control and Prevention (CDC), is to follow their 2005 "Guidelines for the Transmission of Mycobacterium tuberculosis in Health Care Fa cilities" and conduct proper diagnostic measures for patients with signs of lung infection and chest radiograph findings suggestive of TB disease. The facility' s TB Exposure Control Plan should be revised to reflect the implementation of th is. References: 1) Nevada Administrative Code 441A.200: Infectious Diseases. Lis t of adopted recommendations, guidelines and publications; review of revision or amendment of adopted recommendation, guideline or publication: The following re commendations, guidelines and publications are adopted by reference: (h) The rec ommendations of the Centers for Disease Control and Prevention for preventing th e transmission of tuberculosis in facilities providing health care set forth in "Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Hea lth-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. Prompt Triage A diagnosis of respira tory TB disease should be considered for any patient with symptoms or signs of i nfection in the lung, pleura, or airways (including larynx), including coughing for more than 3 weeks, loss of appetite, unexplained weight loss, night sweats, bloody sputum or hemoptysis, hoarseness, fever, fatigue, or chest pain.The index of suspicion for TB disease will vary by geographic area and will depend on the population served by the setting. The index of suspicion should be substantiall y high for geographic areas and groups of patients characterized by high TB inci dence (26). Clinical Diagnosis A complete medical history should be obtained, includin g symptoms of TB disease, previous TB disease and treatment, previous history of infection with M. tuberculosis, and previous treatment of LTBI or exposure to p ersons with TB disease. A physical examination should be performed, including ch est radiograph, microscopic examination, culture, and, when indicated, NAA testi ng of sputum (39,53,125,126). If possible, sputum induction with aerosol inhalat ion is preferred, particularly when the patient cannot produce sputum. Gastric a spiration might be necessary for those patients, particularly children, who cann ot produce sputum, even with aerosol inhalation (127- 130). Bronchoscopy might b e needed for specimen collection, especially if sputum specimens have been nondi agnostic and doubt exists as to the diagnosis (90,111,127,128,131-134). All patients with suspected or confirmed infectious TB disease should be placed under airborne precautions until they have been determined to be noninfectious ( see Supplement, Estimating the Infectiousness of a TB Patient). Adult and adoles cent patients who might be infectious include persons who are coughing; have cav itation on chest radiograph; have positive AFB sputum smear results; have respir atory tract disease with involvement of the lung, pleura or airways, including l arynx, who fail to cover the mouth and nose when coughing; are not on antituberc ulosis treatment or are on incorrect antituberculosis treatment; or are undergoi ng cough-inducing or aerosol-generating procedures (e.g., sputum induction, bron choscopy, and airway suction) (30,135). Chest Radiography Chest radiographic abn ormalities can suggest pulmonary TB disease. Radiographic abnormalities that are consistent with pulmonary TB disease include upper-lobe i nfiltration, cavitation, and effusion. Infiltrates can be patchy or nodular and observed in the apical (in the top part of the lungs) or subapical posterior upp er lobes or superior segment of the lower lobes in the lungs. Evaluation of Sput um Samples Sputum examination is a critical diagnostic procedure for pulmonary T B disease (30) and is indicated for the following persons: - anyone suspected of having pulmonary or laryngeal TB disease; - persons with chest radiograph findi ngs consistent with TB disease (current, previous, or healed TB); - persons with symptoms of infection in the lung, pleura, or airways, including larynx; - HIV infected persons with any respiratory symptoms or signs, regardless of chest rad iograph findings; and - persons suspected of having pulmonary TB disease for who m bronchoscopy is planned.