Put Your N-95 Respirators Away: TB Exposure is on the Decline

The Centers for Disease Control and Prevention and the National Tuberculosis Controllers Association have announced that TB is on the decline. Learn a few of the updated recommendations and how to keep yourself safe. Nurses Headlines News

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Put Your N-95 Respirators Away: TB Exposure is on the Decline

Okay, so maybe it's not time to toss out your N-95. However, a recent update from the Centers for Disease Control and Prevention and the National Tuberculosis Controllers Association shows an overall decline of TB cases. The organizations also report that TB cases following occupational exposure have dropped, too.

This new information has created a few updated recommendations

  • All healthcare personnel should get a baseline TB risk assessment, screening for symptoms, and TB skin or blood test upon hire
  • Annual testing is not recommended for healthcare personnel unless there is a known exposure or ongoing transmission in your facility
  • Personnel with an untreated latent TB infection should be screened each year for symptoms and treatment is highly-encouraged
  • All staff should receive yearly TB education, which includes information about risk factors, TB infection control policies and procedures, and a list of signs and symptoms
  • Personnel with a positive TB skin or blood test should be evaluated for symptoms and have a chest x-ray performed to rule out the disease

Understanding Your Risk

Tuberculosis is an infectious disease that mainly affects your lungs. TB is spread through tiny droplets that are released into the air following sneezing and coughing. Once it's in the air, the droplets can be breathed in by others, and they can become infected. The disease was once thought to be rare in developed countries. However with the increase of HIV, it gained momentum in the mid-1980s.

The disease is difficult to treat because many drugs have become resistant. Treatment can take several months, and the patient will need to be separated from others until they are no longer actively contagious.

Symptoms

Active TB creates severed illness. It can make you sick shortly after you contract the condition, or it can make you sick years later. The main signs and symptoms include:

  • Coughing up blood
  • Persistent cough (lasting three or more weeks)
  • Chest pain
  • Fatigue
  • Unintentional weight loss
  • Fever
  • Night sweats
  • Loss of appetite
  • Chills

TB can also remain in your body in an inactive or latent state. This means that you have the bacteria in your body. However, the disease doesn't make you ill. Latent TB can become active, so it's important for people who have latent TB to receive treatment to decrease the spread of the illness.

What Are The High-Risk Populations?

You may be at an increased risk of contracting TB if you work with high-risk populations. Here are a few populations you need to consider:

Patients with Weakened Immune Systems

Your immune system helps to keep you safe from TB and other infections. If you have a weakened immune system, you may be at an increased risk of contracting the condition.

Pediatric or geriatric populations

A few diseases that can put you and your patients at a higher risk include:

  • HIV/AIDS
  • Malnutrition
  • Diabetes
  • Severe kidney disease
  • Drugs used to treat RA, Psoriasis, or Crohn's
  • Chemotherapy drugs
  • Certain cancers
  • Drugs used to prevent rejection of transplanted organs

Traveling to Foreign Areas

TB runs rampant in some under-developed areas. If you or your patient has been to one of these areas, you may need to consider the possibility of TB:

  • Latin America
  • Russia
  • Africa
  • Asia
  • Caribbean Islands

Other Populations

There are a few situations that can also place patients at an increased risk of contracting TB. Those individuals with poor overall health and medical care, those with substance abuse issues or those who use tobacco are more vulnerable to TB.

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Melissa Mills

About Melissa Mills, BSN

Workforce Development Columnist

Melissa is a professor, medical writer, and business owner. She has been a nurse for over 20 years and enjoys combining her nursing knowledge and passion for the written word.

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Specializes in Public Health, TB.

Your article title is not great; nurses still need N-95 masks for airborne illnesses like measles and flu. Perhaps a better title would be "Say good-by to annual TSTs or IGRAs".

I think its also important to state that persons with a positive skin test or blood test should not receive annual chest X-rays. These are only necessary if they show signs of active disease.

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Specializes in Gerontology.

No one who worked during the SARS epidemic will be getting rid if their N95 masks.

Just saying

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Specializes in Workforce Development, Education, Advancement.
11 hours ago, nursej22 said:

Your article title is not great; nurses still need N-95 masks for airborne illnesses like measles and flu. Perhaps a better title would be "Say good-by to annual TSTs or IGRAs".

I think its also important to state that persons with a positive skin test or blood test should not receive annual chest X-rays. These are only necessary if they show signs of active disease.

Thanks for your comment, Nursej22. It was supposed to be a bit of tongue-and-cheek humor. Of course, no one can put their N-95 masks away. However, the decline of TB cases in the U.S. is encouraging.

7 hours ago, Pepper The Cat said:

No one who worked during the SARS epidemic will be getting rid if their N95 masks.

Just saying

Hi Pepper The Cat! Of course they won't and nor should they. The title was a bit of tongue-in-cheek humor. Thanks for your comment!

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Specializes in Public Health, TB.

I work in a local health department in a TB program. Rather than listing continents or areas, we consider any location outside of the US and Western Europe as at risk.

Russia is both in Europe and Asia.

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Specializes in Public Health, TB.

Oops, anywhere outside of the USA, Canada, and Western Europe.

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Specializes in jack of all trades, master of none..

When reading articles like these, I always look at the numbers and when they are collected. Right now we are facing an increase in TB at the southern border because we have people coming in not just from South America but from Pakistan, Iran, China, etc. The CDC has not dealt with those stats and in fact, I do not believe they are actively surveilling.

If I could go back in time, I would have been much more aware of TB during the 1980s when Haitian's were coming into the country. I would have insisted our ER nurses and doctors wore masks during any contact as many of us became infected. Please, nurses, 'due diligence' is a must. We must care for ourselves in spite of 'offending someone' when wearing a mask. Remember if you do not take care of yourself, you can not take care of others.

Helen

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Specializes in Public Health, TB.

All active cases are reported to the CDC, I know because that is part of my job. Yes, there is a lag in reporting numbers, but that has to do with collecting and compiling data.

Also, refugees undergo a medical screening exam that includes communicable diseases including TB. Yes, universal precautions would include donning a mask in the presence of productive cough. I personally am much more concerned about picking up viral influenza than TB, which is a slowly progressing, treatable bacterial infection.

In the event of a exposure, health care personal should be tested either by skin test or a blood test. Health care agencies are required to have a plan about TB control.

For what it's worth, 1/2 of our recent active cases are US born, likely exposed when traveling overseas. I don't think its fair to blame all TB on immigrants, refugees, or asylees.

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Specializes in jack of all trades, master of none..

They don't have the health care professionals in the number to check that many people and there are quite a few coming through desert areas unmanned by border control.

I am really not targeting legal immigrants. I am specifically looking at people coming illegally and without border control contact.

I came into contact with that group of people when working. We have a problem and it needs to get corrected. Do you work in a border state?

Helen

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Specializes in Public Health, TB.
2 hours ago, protos frontida 9 said:

Do you work in a border state?

Yes, I do as a matter of fact. So you are saying that people who have traveled thousands of miles, some of through rugged desert are ill with pulmonary TB disease, with overwhelming fatigue, severe weight loss, fevers and hemoptysis.

Got it.

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Specializes in jack of all trades, master of none..

That would assume they started with symptoms and is not necessarily the case. People can become infected over less time in a closed space such as the back of a van and over 2-3 days. Not only that if you are working in a border state as an Infection Control Nurse and collect data, then you know that many an individual is passing over without any contact with border control or health care provider contact. Laredo has a deep gully that you can walk from Larado, Mexico to the Larado, USA. It is not difficult. Larado is not the only place in Texas; a person can step over. In Arizona, some areas are wide open. Same in New Mexico. I have lived in all these states.

My point is the numbers may show a decrease in TB because we are not collecting all the data. We do not check people coming over on planes or boats for TB or any other disease, but after the Ebola incident, they added some questions at doctor's offices in the U.S.

We need to get a handle on who is coming into our country. The experience of having the Haitians coming into our country during the 1980s with so many cases of active TB left a sour note. They not only came with infectious diseases, but they also came with a high incidence of mental health problems.

And later, during one of the National Conferences of the CDC, we were told that TB and other diseases often become resistant to antibiotics and other drugs. When people became resistant to antibiotics and developed MRSA, we had trouble with saving lives.

Then we got hit with the crisis of AIDS/HIV in the 1990s and could not figure out how to stop it. The CDC informed everyone at a National Conference that they made a choice not to publically come out with a statement for fear that health care professionals would leave the medical field.

Do you go to the National Conferences from the CDC? It looks like they had one in March of this year on HIV again. I learned a lot from them and some things I did not want to learn but the experience of having so many people with expertise in areas of a good experience. I often thought of working for the CDC in Atlanta, Georgia.

I have much respect for you and know that you are doing what you can to pinpoint problem areas and make correct recommendations to those who will listen.

My issue is that we need to start with the simple things like monitoring our border closer and finding out who is here. We have so many homeless people that are dying on our streets. Most of them are Americans.

Helen

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Specializes in Public Health, TB.

Helen, I respect you as well and it sounds like you have lived through several events around infectious diseases. The good news is many have effective vaccines, and as I previously stated, vaccine rates in most other countries are higher than in the USA. It appears that an effective Ebola vaccine has been developed, and one for TB is in the works. An effective treatment regime for drug resistant TB has just been approved.

Regarding the influx of undocumented immigrants, I believe that addressing the issues that people are fleeing would be more effective than a barrier that would take decades to complete.

Regarding Haiti, I recommend a book about Dr. Paul Farmer titled “Mountains Beyond Mountains.”

I mainly attend TB and vaccination conferences.

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