Healthcare Worker Behavior and Workflow Changes for the Care of Patients in Isolation Precautions

Abstract

mentation, reevaluation, and then final documentation. For staff members who require a second reminder letter, or forget to return for the reading, more time is required. After analyzing 5 consecutive years of data and review of NJ State TB Risk Assessment guidelines, our team concluded that we are designated a low risk facility for TB. Our hospital had no newly diagnosed TB patients, zero employee exposures, zero employee conversions and a total of 5 TB patients for the entire county. PROJECT: Our Infection Prevention and Control Committee reviewed the 2005 CDC guidelines for preventing transmission of M. tuberculosis in health-care facilities. The document states: “the recommended frequency of testing of employees for M. tuberculosis infection varies, depending on the institution’s level of risk.” One of our ID physician champions and chair of our Antibiotic Stewardship Committee drafted a letter to the NJ State TB Program Director requesting to re-evaluate the need for annual employee TB testing based upon our historically low TB rates and low-risk designation for five uninterrupted years. RESULTS: In April 2012 we received the approval to suspend our annual employee screening. This decision was based on the historically low number of TB cases treated at the hospital, and the low probability of an exposure to undiagnosed TB due to low incidence in the community. Upon approval, our TB Control Program Plan was modified to include: providing the initial twostep employee Mantoux Tuberculin Skin test for new hires, developing an annual employee TB symptom assessment completed with annual N95 mask fit testing and an expanded contact investigation procedure for any future exposures. Our new TB control plan included the annual TST screening must resume if the criterion for “medium risk” is reached in any subsequent year. LESSON LEARNED: Resources are being stretched to their limits due to growing state and federal mandates and reporting requirements. Programs must reevaluate their current scope of services and surveillance practices to be in compliance with added regulations. Hospitals with a low TB risk category may benefit from reexamining Tuberculosis data to determine if annual TB practices that can be safely stopped.