Tuberculosis Exposure Plan

According to the CDC, "It is important to know that a person who is exposed to TB bacteria is not able to spread the bacteria to other people right away. Only persons with active TB disease can spread TB bacteria to others."

"Some people develop TB disease soon (within weeks) after becoming infected, before their immune system can fight the TB bacteria. Other people may get sick years later, when their immune system becomes weak for another reason. Many people with TB infection never develop TB disease." http://www.cdc.gov/tb/topic/basics/exposed.htm

Students will not be held from clinical practicum experiences unless they have an active TB infection, not TB disease. Active TB is determined using TB screening and confirmation by qualified health care providers/professionals based on symptoms of active TB.

Tuberculosis (TB) exposure potential is defined as any exposure to the exhaled or expired air of a person with suspected or confirmed TB disease. A high hazard procedure involving an individual with suspected or confirmed TB disease is one that has the potential to generate potentially infectious airborne respiratory secretions such as aerosolized medication treatment, bronchoscopy, sputum induction, endotracheal intubation, and suctioning. Workplaces with inherent exposure potential to TB disease:

• Health care facilities

• Corrections facilities

• Homeless shelters/clinics for homeless

• Long term health facilities

• Drug treatment centers

• Post-exposure Procedure

1. When a Tuberculosis (TB) exposure occurs, the involved student will report the incident to the course instructor and the appropriate administrative staff at the involved institution or agency.

2. The student will be counseled immediately and referred to his or her personal health care provider, or local Health Department.

3. A baseline Tuberculosis Skin Test (TST) should be administered as soon as possible after the exposure.

4. Frequency of follow-up TSTs will be performed per provider protocol. A TST performed 12 weeks after the last exposure will indicate whether infection has occurred.

5. A student with evidence of new infection (TST conversions) needs to be evaluated for active TB. Even if active TB is not diagnosed, prophylactic therapy for latent TB is recommended.

6. A student with a previously documented reactive TST need not be retested but should have a baseline symptom screen performed following the exposure and repeated 12 weeks after the exposure. If the symptom screen is positive a chest x-ray is required.

7. Any active case of TB must be reported to local Health Department.

Return to Class for Active TB

A student diagnosed with active pulmonary or laryngeal TB may be highly infectious; and will not be able to attend class or clinical practicum experiences until he/she is noninfectious. In order to return to school, the student will need to provide documentation from the health care provider that he/she is noninfectious. The documentation needs to include evidence that:

• The student has received adequate therapy for a minimum of 2 weeks.

• The cough has resolved, and the student is not experiencing chest pain, hemoptysis, fever or chills.

• The results of three consecutive sputum acid-fast bacilli (AFB) smears collected on different days are negative

Documentation and Financial Responsibility

• After the student returns to school and remains on anti-TB therapy, periodic documentation from their health care provider is needed to show that effective drug therapy is being maintained for the recommended period and that the sputum AFB smear results remain negative.

• The student is responsible for all costs related to the exposure incident.

• The student’s health records will be maintained in a confidential file.