Tb

last night we get a pt from ER with HIV/AIDS and all kinds of communicable/reportable infections. of course like always ER dumps the patient in the room and leaves without a report... which they fax to us after ALL the nurses and aides on our floor have been in the rm.

So, what does the order say that we get 10 mins after the pt is on the floor? "Place PPD on patient, to be read in 24-48hrs." ARE YOU KIDDING? Respiratory isolation anyone? ER doc *suspected*the patient had TB. Ends up he did. I went in all 30 rooms at 0400 to get vitals and do I/Os.

I know the chances of getting it from this are low...but still, someone really should have called verbal report on this.

Tell me this has happened to someone else.

If a pt is suspected of having TB, they are to be kept in isolation/airborne precautions till proven otherwise. But i think some doctors dont take these preventative measures serious, putting you at risk for catching something. Follow up with employee health for further/future testing.

If a pt is suspected of having TB, they are to be kept in isolation/airborne precautions till proven otherwise. But i think some doctors dont take these preventative measures serious, putting you at risk for catching something. Follow up with employee health for further/future testing.

Yea we all had to get a TB skin test done this morning... like I said, the chances are very rare, but still. And all the nurses went back in to their patient's rooms then I went in all the rooms to get vitals.

they have to be placed not just on airborne isolation or droplet if they suspect ACTIVE TB, but need to be in a negative pressure room or tent. Patients can have TB without actually having ACTIVE TB. That is what a PPD is for. Some people will test positive with a PPD and yet not have TB. Henceforth, thats when they do a chest x ray or further test such as a acid fast bacillus sputum culture. However, in this case where the pt. did have TB. Did they confirm with a chest x ray and acid fast bacilli sputum culture? Because a positive PPD is not enough to diagnose an active case of TB. Its used as a screening test rather than a diagnostic test. Hope this helped.

This happened in our ICU this week. Patient DX with TB after the fact, all the ICU doors were wide open letting the droplets float in the air - and the beat goes on. Dr. suspected TB but didn't place patient on isolation, nor did he document that he suspected TB until a couple days later. Its a wonder anybody is left on planet earth!

That sucks. This happens all the time.

I remember we got a patient from the ER and on the admitting orders it said r/o SARS. I was like WHHHHAAATTTTT!!!!!!! The md should not have written that, and it was completely wrong.

I know what you mean. My TB skin tests have always been positive but only because I've been exposed to it in the past... CXR is always negative.

The sad part is the same ER doc that suspected TB and ordered the PPD didn't order a 2vCXR in the emergency dept. However, the patient's CXR a few hours later was positive and he was placed in a negative pressure room. Luckily no one working our unit that night was positive.

However this is scary, and I'm glad we decided to treat him as droplet precautions and mask up and we closed his door. But still...that air is circulated around the hospital.