Risks Post TB....what would you do?

[Little Mermaid]

Hello Everyone!

First I would like to tell you a bit about myself as I am new here & other than the post in the newbie forum with more details of myself & my Autisic son but this is my first real post...

Now I have been Nursing for nearly 17 years & currnetly I work as an Agency Nurse & it is not uncommon to frequent some places more than others.....& last night was no exception...cause I go to this place 3-4 shifts a week.

Anyway it all started as normal with usual handover then I went down stairs to high care.

At about 1630 as I was about to give this new man his ventolin & seretide he began coughing all over me, then he says to have a look at this and hands me a plastic cup from earlier that morning with about 30mls of sputum:barf02:which had bits of blood in it & tells me he would like to see a Doctor in the morning..So I rang upstairs to talk with the team leader EEN (who happens to be leaving next week & has stated he doesn't want to be there... and sadly it begining to reflect on his Nursing) anyway he rudely say's they are aware of it & they would not have him here if he were contagious & not to worry about it & just continue as normal.

Then at 1800 I went back to check on him & he was short of breath & had fresh blood all over the floor & on top & bottom sheets...after checking him over to make sure it wasn't a cut or from a fall but he states he coughed it all up...at this stage I went to check his progress notes only to find he has COAD & Post TB as well as other illnesses & none of this had been handed over to me nor had the EEN inform me when I spoke to him earlier in shift. :angryfire

I tried to contact the EEN again to inform him of the latest episode of blood all on the floor & bed but I was unable to get a hold of him because he was on tea break...I tried for the next 45 mins but was only able to get a message to him...but by 1850 I decieded to go for my break before the next med. round

I came back from my break to find a note on med. book [give his meds early ] which was only seritide & ventolin....that was it.

The other thing is they had no PPE in place or seperate linen bag for contaminated linen or wastes so all the bloody linen went in normal contaminated linen (which is primarly used only for dirty bowel motion)

Ok so my concern is if this man is regularly coughing up blood with mucus or just fresh blood then surely the TB is active which would make him contagious......would it not????

Now my concern is ....as a single mum of a child with lots of medical complications & having stomach ulcers & not the best immunity & easily catch things myself.

I have 5 more shifts booked for this place over the next week ...

So my Questions to you are .....

1. Would you care for this man?
   
2. If you would, would you still do it if you only had gloves as PPE?
   
3. If he is contagious....& there is a slight possibility I am at risk do you think I should be tested & when is the best time?
   
4. Do you think I am overeacting & making more into this than nessesary?

[chenoaspirit, ASN, RN]

Well, he needs a sputum sent to lab pronto and a chest xray done. Although there are other things that can cause blood in sputum, I would definitely wear an airborne mask and treat this patient as if he does have TB. If that wasnt available, no I would not care for him. The hospital needs to provide protective equipment to their staff. No on is worth my health. I dont meant that in a bad way, I will care for any patient as long as I have the equipment I need to protect myself.

[Little Mermaid]

thanks chenoaspirit

that was my view too, but wasn't sure if i was just over reacting or not!

this place does not have any masks or approns available just one size gloves!

i got 4 more shifts coming up at tend of the week & really not too keen given i have too much to risk already.

what do others think?

thanks

[Hoozdo, ADN]

I would refuse to take him as a patient unless you were supplied an N95 mask which is the industry standard for working with TB or r/o TB patients. It also must be fitted for you. If you can get your hands on one, most women wear size SMALL. I would definitely not risk my own health with this patient!

[RN BSN 2009]

Yes, I wouldnt risk it.. Better to be overprepared and healthy than underprepared and put you and your family at risk!

[Little Mermaid]

Thanks everyone

Glad to see there are others out there who think the same....makes me feel better...But I can't see them doing anything different about the situation knowing the place as I do...& don't care about their staff....& I am only an agency....be it that....I must be ok cause I am like a permanant staff I am there 3-4 shifts every week lol but the beautiful thing is I can refuse to go there....& I think that is what I will do....cancel my other shifts I have already booked there!

Thanks everyone!