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What Employers Need To Know

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Title: What Employers Need To Know


1
What Employers Need To Know
Tuberculosis Community Associated Methicillin
Resistant Staphylocoocus Aureus
Kayla Ericksen, RN, BSN Agnesian HealthCare
Infection Prevention
Ann Hermann, RN, BSW Fond du Lac County Public
Health Department
Louann Biddick, APNP Agnesian HealthCare IntegNet
2
Tuberculosis (TB)
  • Just the Facts for the Community

3
The Community Wants to Know!
  • What is TB?
  • How is TB spread?
  • What is TB infection?
  • What is TB disease?
  • Why should businesses care?

4
Why Should You Care?
5
What is TB?
  • TB is a disease caused by bacteria that can
    attack any part of the body, but usually attacks
    the lungs.

6
What is TB?
  • TB infection means the germ is in a persons
    body, but it is inactive and cannot be spread
    to others.
  • TB disease means the germ is active in the body
    and can be spread to others if in the lungs or
    throat.

7
What is TB?
  • TB disease or active TB can be treated and
    cured.
  • People who have TB infection or inactive TB are
    not sick. They may receive medicine so will
    probably not get sick.

8
How is TB Spread?
  • When a person breathes in TB bacteria, the
    bacteria settles in the lung and begins to grow.
  • TB in the lungs or throat can be spread to other
    people through coughing or sneezing.

9
How is TB Spread?
  • TB is spread through the air from one person to
    another.
  • When a person with active TB disease coughs or
    sneezes, bacteria are put into the air.
  • People nearby may breathe in these bacteria and
    become infected.

10
How is TB Spread?
  • When a person breathes TB bacteria, the bacteria
    can settle in the lungs and start to grow. They
    can move through the blood to other parts of the
    body, such as the kidney, spine or brain.
  • TB can become contagious if it spreads to the
    lungs or throat.
  • TB in other parts of the body, such as the kidney
    or spine, is not contagious, but, if untreated,
    can be deadly.

11
How is TB Spread?
  • People with TB disease are most likely to spread
    it to people they spend time with every day -
    family members, friends or co-workers.

12
What is TB Infection?
  • In most people who breathe in TB bacteria and
    become infected, the body is able to fight the
    bacteria to stop them from growing. The bacteria
    become inactive but remain alive in the body.
    This is TB infection or inactive TB.

13
What is TB Infection?
  • People with inactive TB
  • Have no symptoms
  • Dont feel sick
  • Cant spread disease to others
  • Usually have a positive skin test
  • Can develop active TB later if they do not
    receive treatment of their infection

14
What is TB Disease
  • TB bacteria become active if the immune system
    cant stop them from growing. The active bacteria
    begin to multiply in the body and cause TB
    disease or active TB.

15
What is TB Disease?
  • Some people develop active TB soon after becoming
    infected - before their immune system can fight
    the bacteria.
  • Others may get sick later - when their immune
    system becomes weak for some reason.

16
Active TB DiseaseWisconsin, 1997 to 2006
17
Reported TB Cases
18
Drug Resistant TB
19
TB Site of Disease
20
Reported TB Cases By GenderWisconsin 2002 to
2006
21
Age Distribution of TB CasesWisconsin 2006
22
Race/Ethnicity Distribution of TB CasesWisconsin
2006
23
Reported TB Cases by National Origin
24
Who is at Risk for Developing the Disease?
  • Babies and young children often have immature
    immune systems.
  • Elderly people have weak immune systems.
  • People infected with HIV, the virus that causes
    AIDS, have very weak immune systems.

25
Risk Groups for Exposure
  • Close contact of a person with infectious TB
  • Foreign-born persons from areas where TB is
    common
  • Medically underserved
  • Persons who inject drugs
  • Elderly
  • Residents of long-term care and correctional
    facilities
  • Persons who may have occupational exposure to TB

26
What is TB Disease?
  • Symptoms of TB depend on where it is in the body.
    TB in the lungs may cause
  • Sweating at night that soaks through the sheets
  • A bad cough that lasts more than two weeks
  • Pain in the chest

27
What is TB Disease?
  • Other symptoms of TB disease are
  • Weakness or fatigue
  • Weight loss
  • No appetite
  • Chills
  • Fever
  • Coughing up blood

28
You Cant Get TB From
  • Bed sheets or towels used by someone with TB
  • Sharing cups or dishes
  • Toilet seats
  • Spit on the sidewalk
  • Telephones
  • Someone with TB infection (only)

29
TB Screening
  • Verbal screen for signs and symptoms
  • Quantiferon Gold pre-employment first year of
    employment as a baseline
  • Following years of employment TB Skin Test prior
    to beginning work
  • Chest X-ray if positive skin test or Quantiferon

30
Tuberculosis Control in Your Community We have a
plan! The Local Health Department (LHD)
coordinates TB prevention efforts for the
community.
31
Why Should You Care?
32
Community Associated MRSA
33
Staphyloccocus Aureus (Staph)
  • Staphyloccous aureus staph bacteria commonly
    carried on the skin or in the nose of healthy
    people.
  • Approximately 25-30 of the population colonized
    (bacteria present, but not causing infection)
  • Most common cause of skin infections in the
    United States

34
What is MRSA?
  • Methicillin-Resistant Staphylococcus Aureus
  • When Staph Aureus becomes resistant to the common
    antibiotics (known as Beta-lactam antibiotics)
    used to treat infections, like penicillin,
    amoxicillin or methicillin, it is referred to as
    MRSA.
  • About 1100 people are infected (colonized) with
    MRSA. Often they are not sick, and in many cases
    are not even aware they have it.

35
Who Has MRSA?
  • Anyone can get this bacteria
  • It has been more commonly seen in healthcare
    settings, such as hospitals or nursing homes.
  • This disease is called Healthcare Associated MRSA
    (HA-MRSA). It usually affects people who are
    already ill from some other disease, have a
    weakened immune system or have an indwelling
    device, such as a foley catheter or a central
    line.
  • Often the bacteria will cause wounds to become
    infected. It can cause pneumonia or a urinary
    tract infection.
  • Community Associated Methicillin Resistant Staph
    Aureus (CA-MRSA) started emerging in the 1990s
    and is genetically distinct from HA-MRSA.

36
Who has MRSA?
  • Healthcare providers are seeing more Community
    Associated MRSA (CA-MRSA).
  • 75 percent of these people present with skin
    infections that may look like impetigo, small
    watery blisters or a draining rash.
  • It can also appear as pimples, boils, or in the
    very early stages be mistaken for spider bites.
  • These otherwise healthy people have had no recent
    association with the healthcare system or long
    term illness that would have compromised their
    immune system.

37
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Photo from Dr. Gerard Lina, Hospital of Lyon
40
Photo from Dr. Gerard Lina, Hospital of Lyon
41
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42
Who has MRSA?
  • Early study results appear to indicate that
    CA-MRSA is more virulent and spreads easier from
    person to person.
  • Other factors that influence the spread of MRSA
    are close skin-to-skin contact non-intact skin,
    such as cuts, abrasions or rashes, crowded living
    conditions and poor personal hygiene.
  • Clusters of CA-MRSA have been investigated among
    athletes, American Indians, Alaskan Natives,
    military recruits, prisoners and men who have sex
    with men.

43
How is MRSA Treated?
  • Usually a culture is done to identify the
    bacteria.
  • In most cases of CA-MRSA wound infections, the
    doctor only does an incision and drainage of the
    wound, allowing it to heal on its own.
    Occasionally a topical antibacterial ointment may
    be applied.
  • Antibiotics that the bacteria are sensitive to
    may be ordered and need to be taken and finished
    exactly as ordered.

44
How is MRSA Treated?
  • Generally speaking, colonized, non-ill people are
    not treated (decolonized).
  • An exception to this may be healthcare workers,
    especially if they may be a link to the
    transmission of MRSA in their work setting.

45
How Long Can MRSA Last?
  • This varies greatly from case to case. In part,
    it depends on how severe the infection is.
  • Incision and drainage and/or antibiotic therapy
    will usually heal the infected wound, but the
    person may continue to be colonized (infected but
    not sick).
  • Once the MRSA is gone, the person can be
    re-infected - maybe from the original source or
    maybe from himself. The cycle can repeat.
  • Colonization can be intermittent or persist
    weeks, months and even years.

46
How is MRSA Spread From Person to Person?
  • MRSA is usually spread by direct contact.
  • It can also be spread by coughing from someone
    who is colonized in their throat or from nasal
    secretions with sneezing or nose blowing, usually
    from the hands to surfaces.
  • By sharing of personal items such as towels,
    razors, lip balm or contaminated clothing.
  • Drainage on items, like door knobs or shared
    items.

47
MRSA
  • Keep in mind, you will not always know who has
    MRSA.
  • People who are colonized can shed the bacteria.
    They will look and feel healthy and often they
    dont know they carry it.

48
What Businesses Can Do
  • Pre-employment Screening
  • Physicals
  • Blood work
  • Immunizations
  • TB
  • Quantiferon Gold
  • Chest X-ray

49
Why Should Businesses Care?
  • Reduce the threat to all co-workers.
  • Reduce the threat to the community.
  • Identify the infection early and treat before it
    becomes active.
  • Active disease is labor intensive and expensive
    for employers.
  • Requires many health department resources.
  • Active cases cause a great deal of fear in the
    work place and community should they become aware
    that a facility has a case of TB.

50
Prevention Tips
  • Good physical hygiene includes
  • Hand washing, use of a alcohol-based hand
    sanitizer when hands are not visibly soiled or
    when water is not available.
  • Regular changing of soiled dressings - disposing
    of them appropriately in a plastic bag in the
    garbage.
  • Keeping wounds covered and dry with dressings and
    clothing - change if moisture soaks through.
  • Frequent changing of bed linens.
  • Not sharing towels or washcloths.
  • Adequate laundering of all items in direct
    contact with employee.
  • Encouraging employees to cover coughs and sneezes
    (respiratory etiquette).
  • Frequent hand washing.

51
Effective Hand Washing Includes
  • Use soap and warm running water
  • Wet hands
  • Rub soap all over your hands for 15 seconds - pay
    particular attention to fingernails.
  • Rinse under running water.
  • Dry hands with clean towel - paper towels are the
    best.
  • Use the towel to turn off the faucet.
  • When soap and water are not available, use an
    antibacterial hand rub.

52
Prevention Tips
  • For effective environmental cleaning, frequent
    use of cleaning sanitizers, such as industrial
    disinfectants or a diluted bleach solution should
    be used on surfaces that may be contaminated. Use
    also in bathrooms and on faucets that may be used
    for hand washing or changing of dressings.
  • If there is a health club or exercise facility on
    site, ensure that the equipment is cleaned
    between uses.

53
Prevention Tips
  • Promote the use of good personal hygiene and
    respiratory etiquette by covering coughs and
    having Kleenex (tissues) available.
  • Have waterless hand sanitizer available for
    employees.
  • Keep washable surfaces free of clutter so they
    can be wiped down with a disinfectant frequently.
  • Encourage employees not to use a fellow
    co-workers personal items.

54
Top three things you can do to protect others and
yourself from MRSA and a wide variety of other
illnesses
  • Hand washing
  • Hand washing
  • Hand washing

55
Know Your Resources
  • Agnesian HealthCares IntegNet - 926-5666
  • Your local Public Health Department
  • Fond du Lac County - 929-3085
  • Centers for Disease Control, www.cdc.gov
  • Agnesian HealthCare Infection Prevention
    Control - 926-4796
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