NurseNat

Yep, timing is critical. According to the Red Book on Communicable Diseases (2003) "Immune Globulin for IM administration, when given within 2 weeks after exposure to HAV, is greater than 85% effective in preventing symptomatic infection. The use of IG more than two weeks after the most recent exposure is not indicated." Doesn't say why, but I assume it is related to the incubation period, which is approx. two weeks.

You can only give immunglobulin 14 days post-exposure accoriding to our CDC manual.

Here's what I remember from working Public Health (keep in mind this is from Canada). Positive TB skin test (aka Mantoux test or Tuberculin test) means you have been exposed to TB, that's all. If you have a previous negative, the exposure probably happened sometime in the time frame between the tests. The next step is to ascertain if you are symptomatic (weight loss, productive, persistent cough, hemoptysis, night sweats...). If productive cough, then you would send the sputums samples off for culture. Usually chest x-rays are done as well (even if you aren't symptomatic). For the most part, to be infectious, you are more than likely sick...not at all up to work. The most infectious type of patient is "smear positive", they are usually hospitalized and treated until the sputum comes back negative. That's when contact F/U is inititated. It is possible for a person with a positive mantoux and suspicious chest x-ray to be non-infectious. Each TB specialist is different, but most put people on the 6 month INH protocol to be safe. But some docs won't if they at all sense you will not be compliant (resistent strains are getting common). Hope that makes sense! :)

I've heard all the excuses... Please share with me how you have managed to persude your staff to get the flu shot. Unfortunately, it is the front line workers (RN's, Home Support Aides etc) that we have the hardest time convincing. The support staff and stenos are first in line I seem to remember a study showing the increase in mortality/morbidity and transmission from unimmunized workers...ring any bells?? Any suggestions would be appreciated!