TB Protocol

[RNlove17]

Trying to find out what is it, not sure where to look.

I work per diem (used to be full time, got a new job and only work 1x/month there now) at a rehab facility and when a patient tests positive upon admission for TB, they are left in a regular room with no precautions. Usually the admitting PA will say "they are asymptomatic" and they leave it at that. No chest xray, nothing. My introduction to this was when I was a brand spankin' new nurse in this facility, one of the nurse orientating me freaked out when she discovered a pt had a positive PPD (wasn't told during report) and insisted on getting respirator masks. Management gave her such a hard time!! After that, I always used those "duck bill" masks for + PPD test patients, even though no precautions were in place. Where are the negative pressure rooms and isolation precautions I learned about in nursing school? I am still a relatively new nurse, only been practicing for a year.

So is this common/normal procedure and if so/if not, where are places to find the correct procedure. I understand hospital policy but is there anything else?

Thank you!

[SoldierNurse22, BSN, RN]

Really and seriously, utilize Google. I got this first swing from the CDC:

CDC -Transmission-Based Precautions BICPP - HICPAC

...and there's a lot more where that came from. Many, many universities and well-known facilities will publish their protocols online.

Your nursing protocols are not going to encompass the treatment on the physician end of things. That's on them to initiate and follow through. You can only document that you've noted that the patient is positive for TB and that you've set up precautions per your nursing policy.

Keep in mind that not everyone with a positive PPD is contagious or even has TB. Folks who have latent TB, for instance, will have a positive PPD but are not contagious. Folks who were born overseas and vaccinated against BCG may present with a positive PPD though they've never had TB.

I cannot imagine a facility that doesn't have infection control or at least the very basics of transmission-based precautions in place. Scary.