Text For Citation: 01 Item/Group: 006 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 initiate airborne precautions for patients who display signs of tuberculosis (TB). In 2013, at lea st two patients with unrecognized TB disease were admitted into the hospital and cared for by hospital staff, one of whom displayed signs of tuberculosis, prese nting with miliary TB with pulmonary involvement, airborne precautions were neve r initiated. Employees were exposed to Mycobacterium tuberculosis, subsequently causing 20 employees to contract tuberculosis and exhibit either active or laten t forms of the infection. 2)Prior to this inspection, Summerlin Hospital Medical Center's TB Exposure Control Plan did not require initiation of airborne precau tions for all inpatients who exhibit signs or symptoms of tuberculosis (TB) dise ase. The plan only addressed the institution of airborne precautions for patients that ar e known or suspected in the Emergency Room and Admitting Area. The TB Exposure C ontrol Plan also did not specify persons authorized to initiate and discontinue airborne precautions. A feasible and accepted abatement method for reducing thes e hazards, as recommended by the Center for Disease Control and Prevention (CDC) , is to follow their 2005 "Guidelines for the Transmission of Mycobacterium tube rculosis in Health Care Facilities" and initiate airborne precautions for patien ts exhibiting signs or symptoms indicative of TB disease. The facility's TB Expo sure Control Plan should be revised to reflect the implementation of this. Refer ences: 1) Nevada Administrative Code 441A.200: Infectious Diseases. List of adop ted recommendations, guidelines and publications; review of revision or amendment of adopted recommendation, guideline or publication: The following recommendations, guidelines and publications are adopted by reference: (h) The r ecommendations of the Centers for Disease Control and Prevention for preventing the transmission of tuberculosis in facilities providing health care set forth i n "Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in H ealth-Care Settings, 2005," Morbidity and Mortality Weekly Report[54(RR17):1-141 , December 30, 2005]. 2) "Guidelines for Preventing the Transmission of Mycobact erium tuberculosis in Health Care Facilities," 2005. Centers for Disease Control and Prevention (CDC), MMWR December 30, 2005/Vol. 54/No. RR-17. TB Airborne Pre cautions Within health-care settings, TB airborne precautions should be initiate d for any patient who has symptoms or signs of TB disease, or who has documented infectious TB disease and has not completed antituberculosis treatment. TB Airborne Precaution s for Settings in Which Patients with Suspected or Confirmed TB Disease Are Expe cted To Be Encountered Settings that plan to evaluate and manage patients with T B disease should have at least one AII room or enclosure that meets AII requirem ents (see Environmental Controls; and Supplement, Environmental Controls). These settings should develop written policies that specify 1) indications for airbor ne precautions, 2) persons authorized to initiate and discontinue airborne preca utions, 3) specific airborne precautions, 4) AII room- monitoring procedures, 5) procedures for managing patients who do not adhere to airborne precautions, and 6) criteria for discontinuing airborne precautions.