Tuberculosis is making a comeback

Abstract

Nancy J. Girard, RN When I was very young, my uncle lived next door to us, and I spent a lot of time with him. One day, to my great shock and abject fear, he began to cough up blood. Soon it became a torrent. I screamed for help as he collapsed near me, covered with blood. My grandmother came running with car keys, and we bundled him into the car and drove him to the hospital. The next time I saw him was on a visit to a tuberculosis (TB) sanitarium, a care facility that promoted fresh air and good nutrition for those with TB. He eventually recovered and returned home, but several years later he died of the disease. Years later, I was working in the OR of a small hospital. It was an institution in which all the nurses had to know how to work in every area because we would work wherever we were needed. One day, we performed a tonsillectomy and adenoidectomy on a three-year-old child. She was a beautiful girl with an angel face, long blonde curls, and a sweet smile. The surgery went well, but for some reason hidden to us, she had problems in recovery. She was admitted to the floor where I was called to work when the OR was quiet, and she stayed for a week. I became too attached to her, which is something that happens to every nurse at some time during his or her career. She was discharged, and I thought of her often. Three months after her discharge, I was called to the emergency room. There was my angel, comatose and barely breathing. To my sorrow, she died shortly thereafter. We were told that she was in an advanced stage of TB, and it was in her bones and organs. You might ask why I am remembering these traumatic and emotional events. It is because TB is making a comeback, and it is a highly transmissible disease. In other countries, especially those with a high incidence of HIV, TB is very common; it is estimated that one-third of the world's population is infected with TB.1 Although the incidence remains low in US populations, it is increasing among foreign-born persons living in the United States. The states with the highest incidence of TB are those in the southern east, central, and western border states, Alaska, and Hawaii.2 It was estimated that the number of persons with TB in the United States in the year 2001 was 284,797,000.3 Around the world, it is estimated that up to 50 million people are infected with multiple-drug resistant (MDR) TB, and 300,000 new cases are diagnosed each year.4 The emergence of MDR TB, defined as TB resistant to two or more of the treatment medications, is a serious complicating factor,4 and it is common today to find TB that is resistant to three or more medications.4 Worldwide, concern about the increase in TB and especially the virulent MDR TB is great. The World Health Organization has launched a 2006–2015 Global Plan to Stop TB. The Stop TB strategy includes pursuing high-quality DOTS (ie, directly observed treatment, short-course) expansion and enhancement; addressing TB/HIV, MDR TB, and other challenges; contributing to health system strengthening; engaging all health care providers; empowering people with TB and communities; and enabling and promoting research.1 Nursing students study TB in nursing school, and health care workers are immunized and tested for the disease. In the recent past, however, like measles, whooping cough, and polio, TB was no longer considered to be much of a threat in the world of transmissible diseases. Modern research and treatment options had diminished these contagious diseases, but they were always there, waiting for the opportunity to re-emerge. Implications of the emergence of MDR TB for perioperative nurses are obvious, particularly for those who work in geographical areas where MDR TB is increasing rapidly. Tuberculosis is transmitted through the respiratory system and can spread with talking, coughing, laughing, and sneezing. Patients at highest risk for developing TB are those with the lowest immune response, such as those with cancer, AIDS, leukemia, and diabetes, and those who are elderly.4 Patients of all ethnicities can contract TB, but those who are black, non-white Hispanic, Asian, or Pacific Islanders have a higher incidence of acquiring TB.3 Taking precautions for any transmissible disease is essential. The new AORN “Recommended practices for prevention of transmissible infections in the perioperative practice setting” is published in this issue of the Journal. I hope you all will read and apply this important information so you are better prepared to practice safe nursing both for yourselves and for your patients.