What Employers Need To Know

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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
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Tuberculosis (TB)

• Just the Facts for the Community

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The Community Wants to Know!

• What is TB?
• How is TB spread?
• What is TB infection?
• What is TB disease?
• Why should businesses care?

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Why Should You Care?
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What is TB?

• TB is a disease caused by bacteria that can
  attack any part of the body, but usually attacks
  the lungs.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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

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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.

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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.

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Active TB DiseaseWisconsin, 1997 to 2006
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Reported TB Cases
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Drug Resistant TB
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TB Site of Disease
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Reported TB Cases By GenderWisconsin 2002 to
2006
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Age Distribution of TB CasesWisconsin 2006
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Race/Ethnicity Distribution of TB CasesWisconsin
2006
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Reported TB Cases by National Origin
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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.

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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

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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

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What is TB Disease?

• Other symptoms of TB disease are
• Weakness or fatigue
• Weight loss
• No appetite
• Chills
• Fever
• Coughing up blood

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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)

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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

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Tuberculosis Control in Your Community We have a
plan! The Local Health Department (LHD)
coordinates TB prevention efforts for the
community.
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Why Should You Care?
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Community Associated MRSA
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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

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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.

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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.

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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.

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Photo from Dr. Gerard Lina, Hospital of Lyon
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Photo from Dr. Gerard Lina, Hospital of Lyon
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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.

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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.

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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.

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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.

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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.

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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.

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What Businesses Can Do

• Pre-employment Screening
• Physicals
• Blood work
• Immunizations
• TB
• Quantiferon Gold
• Chest X-ray

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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.

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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.

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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.

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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.

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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.

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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

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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