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October 28, 1994 the CDC issued guidelines for tuberculosis prevention.
The intent of the CDC draft guidelines is similar to that of the OSHA
enforcement guidelines on Tuberculosis. The document updates and
replaces all previously published guidelines for the prevention of
Mycobacterium tuberculosis transmission in health-care facilities. The
document presents a well organized plan of:
a) the hierarchy of control measures, including administrative and engineering controls and personal respiratory protection
b) use of risk assessments for developing a written tuberculosis (TB) control plan
c) the early identification and management of persons who have TB
d) TB screening programs for health care workers (HCWs)
e) HCW training and education
f) the evaluation of TB infection-control programs.
These
CDC guidelines are a much stronger document in favor of fire fighter
and emergency responder protection then past guidelines. For example,
significant changes of note are:
•
The inclusion of emergency medical service (EMS) personnel in the
definition of Health Care Worker (HCW) as an individual working in
health-care settings who has the potential for exposure to M.
tuberculosis.
•
The recommendation of HEPA and NIOSH approved type C respirators as the
primary means of personal protective equipment. Furthermore, the
document provides that Emergency medical services as a health care
setting should have at a minimum the following components in its
tuberculosis control plan:
• At a minimum, a risk assessment should be performed yearly
• A written TB infection-control plan should be developed, evaluated, and revised on a regular basis
• Protocols should be in place for identifying and managing patients who may have active TB
• HCWs should receive appropriate training, education, and screening
• Protocols for problem evaluation should be in place
• Coordination with the public health dept. should be arranged when necessary.
Other recommendations specific to Emergency medical services include:
•
When EMS personnel or others must transport patients who have confirmed
or suspected active TB, a surgical mask should be placed, if possible,
over the patient’s mouth and nose. Because administrative and
engineering controls during emergency transport situations cannot be
ensured, EMS personnel should wear respiratory protection when
transporting such patients. If feasible, the windows of the vehicle
should be kept open. The heating and air conditioning
system should be set on a non-recalculating cycle.
•
EMS personnel should be included in a comprehensive PPD screening
program and should receive a baseline PPD test and follow-up testing as
indicated by the risk assessment. They should also be included in the
follow-up of contacts of a patient with infectious TB. (As provided for in the Ryan White CARE Law, Subtitle B.)
Action Items
• Obtain a free copy of the document from the CDC at 404-639-1819.
• Perform Risk Assessment of Department, initial and annual
• Write a Tuberculosis infection control plan and protocols
• Provide appropriate TB training
• Obtain a baseline PPD test
•
Select NIOSH approved respirators (HEPA and type C or greater
efficiency) and integrate these respirators into the department’s
respirator protection program as required by 29 CFR 1910.134.
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