Title: What Employers Need To Know
1What 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
2Tuberculosis (TB)
- Just the Facts for the Community
3The Community Wants to Know!
- What is TB?
- How is TB spread?
- What is TB infection?
- What is TB disease?
- Why should businesses care?
4Why Should You Care?
5What is TB?
- TB is a disease caused by bacteria that can
attack any part of the body, but usually attacks
the lungs.
6What 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.
7What 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.
8How 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.
9How 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.
10How 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.
11How 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.
12What 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.
13What 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
14What 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.
15What 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.
16Active TB DiseaseWisconsin, 1997 to 2006
17Reported TB Cases
18Drug Resistant TB
19TB Site of Disease
20Reported TB Cases By GenderWisconsin 2002 to
2006
21Age Distribution of TB CasesWisconsin 2006
22Race/Ethnicity Distribution of TB CasesWisconsin
2006
23Reported TB Cases by National Origin
24Who 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.
25Risk 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
26What 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
27What is TB Disease?
- Other symptoms of TB disease are
- Weakness or fatigue
- Weight loss
- No appetite
- Chills
- Fever
- Coughing up blood
28You 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)
29TB 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
30Tuberculosis Control in Your Community We have a
plan! The Local Health Department (LHD)
coordinates TB prevention efforts for the
community.
31Why Should You Care?
32Community Associated MRSA
33Staphyloccocus 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
34What 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.
35Who 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.
36Who 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.
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39Photo from Dr. Gerard Lina, Hospital of Lyon
40Photo from Dr. Gerard Lina, Hospital of Lyon
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42Who 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.
43How 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.
44How 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.
45How 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.
46How 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.
47MRSA
- 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.
48What Businesses Can Do
- Pre-employment Screening
- Physicals
- Blood work
- Immunizations
- TB
- Quantiferon Gold
- Chest X-ray
49Why 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.
50Prevention 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.
51Effective 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.
52Prevention 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.
53Prevention 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.
54Top 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
-
55Know 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