Will I get TB? - at TB clinic yesterday...

[Abishag]

Okay first of all, I must admit I am paranoid and OCD. I can't help it. I know you are thinking I'll have to get over it in the nursing world but I'm a firm believer that standard precautions are for the most part efficient. I also "freak out a little" when a patient I was working with suddenly has a positive culture for something that requires contact precautions (I mean I have two toddlers at home and not everything requires gloves on standard precautions).

Anyhow, yesterday I had a clinical observation at the TB clinic which is also a refugee clinic. The patients we had yesterday ranged between PPD testing, PPD reading, positive PPD's referred for x-ray, positive x-rays taking DOT's (direct observation therapy), and "sick" couching TB DOT's. ugh.

Here is my concern: I did not see one mask the entire time I was there, the place was undergoing construction and the ventilation was very poor (everyone was coughing including the entire staff), people were getting diagnosed as positive, there wasn't separate seating for anyone (they all sat in the same room), I never saw a nurse dawn a glove ONCE (even during the PPD shot). I did not have direct contact with these people except for the positive TB pt that I auscultated their crackles. So not once did I dawn gloves or mask. Plus people were coughing and the nurses were shaking their hands. I also never saw "said" nurses washing their hands (although on occasion they used the "foam in" but never did they "foam out." I was appalled.

So my question is, WTH? Okay that isn't my question. My question is, what are my chances of getting TB from one day in the office? Am I just too OCD to see this relaxed practice as being dangerous?? Is there something I don't know? Do these nurses probably have TB and that is why they don't care? I'm finding it hard to swallow the memory of yesterday and I get angrier the more I think about it. Please someone calm my fears that one day hasn't infected me!

[Daytonite, BSN, RN]

you can read about tb on the nih and cdc websites (see links below), but here is my understanding of why your chance of coming down with an active infection is close to zero:

1. you are healthy and have a healthy immune system
   
2. even if one of the tb bacteria did get into your system, it is very slow growing and before it has a chance to reproduce your immune system will have walled it off and destroyed it
   
3. to become infected with tb people have to be constantly bombarded with the bacteria over a period of time
   

http://www3.niaid.nih.gov/topics/tuberculosis/default.htm - tb information from the national institute of allergy and infectious diseases

http://www.cdc.gov/tb/ - tb information from the cdc

[VivaRN]

Whoa, just reading your post was giving me a mini-anxiety attack...

No mask for coughing pts in a TB clinic? No isolation or mask for pts with positive PPD before active TB is ruled out? No gloves?

As Daytonite pointed out, your likelihood of getting TB from one day is very very slim. I am more worried about the staff caring for the pts, any immunosuppressed pts getting exposed to pts with active TB - this place is a public health nightmare. They seriously need to clean up their act. Talk to your instructor and notify the county health department. They either need to do some education or shut the place down.

[Abishag]

How scary is it that it IS the health department??

I am definitely reporting to my teachers next week. Hopefully something will be done. And if not...I don't want other students being exposed like that.

[cjcsoon2bnp, MSN, RN, NP]

That doesn't sound safe at all to me, it sounds like they need to take another class in standard procautions. If I were you and had to go back there again I would make sure to practice standard procautions with every patient (even if the other staff aren't) and wear a mask when necessary. Don't forget to mention this to your instructors. Good luck!

!Chris

[Abishag]

Yeah, I don't have to go back but my classmates do and I don't want them being exposed either. Half of them have kids and if anyone picked up TB that would ruin their chances of staying in Nursing school, not to mention we are all together constantly so who knows who it would spread to including the patients we take care of at the hospital.

[TrueAvatar]

Not likely you will get TB.

No likely you will spread TB.

But a little prayer wouldn't hurt. No ones salvation is assured.