TB Testing and Guidelines for EMS Personnel
The Tuberculosis (TB) skin testing guidelines can be found in a document called Guidelines for Preventing the Transmission of Mycobacterium
Tuberculosis in Health-Care Settings 2005. It says, in part,
that EMS
personnel should be included in a comprehensive TB screening program and should receive a baseline
test and follow-up
testing as indicated by the risk assessment. They should also be
included in the follow-up of contacts with patients with infectious TB.
Since Wisconsin is considered to be low risk for TB, no routine testing is recommended
after the initial test upon hire or beginning of EMS work, unless the
person is symptomatic (cough lasting more than two months; cough
productive of sputum; night sweats; fevers; weight loss; bloody sputum)
OR has had a known exposure to a person with TB. When considering
the need for additional TB testing, it is necessary to consider
exposures outside of EMS work, such as medical missions to areas with
high rates of TB.
A positive TST or
blood test does NOT mean the person has TB disease; unless the person is
symptomatic with cough and/or sputum production. That person (who
is asymptomatic) may continue to work as an EMS staff until the medical
evaluation and chest radiograph are complete, and a determination of TB
infection vs. TB disease has been made. A diagnosis of TB
infection means that the person will be offered preventive medication
that decreases the chance that the infection will progress to
disease. A person with TB infection cannot spread TB to others;
ONLY persons with active TB disease can spread it.
Prevention of Exposure of EMS Personnel to
Persons with Known or Suspected TB
Protection of EMS personnel from persons who may
have infectious TB is important. TB is spread through respiratory
droplets which are inhaled by those physically close to the person with
TB, so using standard respiratory care protocols will help to protect
EMS personnel. Persons with an active cough should cover their
cough if at all possible with a surgical mask during care and
transport. EMS personnel may wear fit-tested N95 respirators to
protect themselves from inhaling TB-laden droplets. If a patient
is strongly suspected to have TB, it is important for EMS personnel to
identify themselves to medical personnel as having been exposed to that
person, in case follow-up testing is required. Local public health
departments oversee the investigations into suspect TB, and provide
treatment for those with TB. If EMS personnel need information
about whether they have been exposed, they may call the state or local
public health department for information about exposures.
Transportation of persons with active TB requires
that the patient wear a surgical mask during transport, and that EMS
personnel wear fit-tested N95 respirators. The
guideline for Emergency Medical Services reads as follows:
“The ambulance
ventilation system should be operated in the nonrecirculating mode, and
the maximum amount of outdoor air should be provided to facilitate
dilution. If the vehicle has a rear exhaust fan, use this fan during
transport. If the vehicle is equipped with a supplemental recirculating
ventilation unit that passes air through HEPA filters before returning
it to the vehicle, use this unit to increase the number of ACH.
Air should flow from the cab (front of vehicle), over the patient, and
out the rear exhaust fan. If possible,
physically isolate the cab from the rest of the vehicle.”
“EMS
personnel should be included in the follow-up contact investigations of
patients with infectious TB disease. The Ryan White Comprehensive AIDS
Resource Emergency Act of 1990 (Public law 101--381) mandates
notification of
EMS
personnel after they have been exposed to a patient with suspected or
confirmed infectious TB disease (Title 42 U.S. Code 1994).
The
entire guideline can be found at http://www.cdc.gov/tb/publications/guidelines/infectioncontrol.htm.
(exit DHS)
Summary
Wisconsin
is a low TB incidence state, and numbers of persons with TB have been
decreasing yearly. County-specific numbers and rates can be found
at the website of the State
of Wisconsin TB Program. If you have any questions about test
protocols, results, exposure, or specific patient issues, please call
the TB Program and speak with one of the TB nurse consultants.
PDF:
The free Adobe
Reader® software is needed to view and print portable document
format (PDF) files. Learn
more.
|
