Paramedic Kardex

Overview:

Tuberculosis (TB) is a bacterial infection that is caused by mycobacterium tuberculosis. The bacteria most frequently attacks the lungs. This is referred to as pulmonary TB. Tuberculosis can also affect other areas of the body, and this is called extra-pulmonary TB. The areas most commonly affected are the lymph nodes, the kidney, spine, brain, middle ear, eye, intestines, bones, joints, and larynx. TB infections of the lungs or larynx are the only forms of TB disease that are contagious. TB in other parts of the body is not infectious, as the bacteria cannot become airborne.

 

TB is categorized either as latent TB infection or active TB disease. Most people who breathe in the bacteria in sufficient quantities to actually become infected, will have an immune response capable of stopping the replication of the bacteria. Some of the bacteria will remain alive and inactive, resulting in a latent TB infection. Most people with a latent TB infection will never experience any symptoms and they will never be contagious to others. Latent TB infected people have only a 10% chance of ever developing active TB disease over their entire lifetime.

 

Active TB results when the body’s immune system can no longer stop the bacteria from growing, at which point the person will become symptomatic and potentially contagious.

Mode of Transmission:

Examples of Transmission: T.B. is not a highly infectious disease. Transmission usually requires close, frequent or prolonged exposure to a person with active pulmonary tuberculosis. T.B. is only infectious, if the disease is in the lungs or larynx (Pulmonary T.B.) and the person is coughing the bacteria into the air. Tuberculosis is transmitted through the air from exposure to the bacteria in the saliva of infected persons and sputum coughed up from their lungs. When an infected person coughs or sneezes, tiny droplets, which contain the bacteria, are released and can be inhaled by anyone in the area.

 

Precautions:

Airborne

 

Signs and Symptoms: 

Those exposed to the bacteria who go on to develop an Active TB infection may experience symptoms as follows: 

• Initially a persistent cough with phlegm production (greater than 3 weeks) 

• Fever

• Later chills, fatigue, weight loss, night sweats 

• Coughing up blood (hemoptysis) 

• If the infection were in parts of the body other than the lungs (via bloodstream) such as kidney, lymph nodes, bone, etc. symptoms would be related to those sites.

 

A person with a Latent TB infection will not exhibit any signs and symptoms with the exception of a positive skin test.

 

Exposure Determination

Tuberculosis is considered a moderate exposure. To contract TB, you usually have to be in close quarters for an extended period of time. TB is usually spread between family members, close friends, and people who work or live together. TB is spread most easily in closed spaces over a long period of time. Note there is little danger from the TB patient who is being treated, is taking his or her meds continuously, and is responding well. The drugs usually make the patient noninfectious within weeks.

 

General Post Exposure Treatment 

A PPD test should happen within 10 days after being notified of the exposure. It also needs to be repeated 10- 12 weeks after the exposure. Follow up care should begin with an infectious disease specialist promptly if the PPD test results in a conversion

 

TB is completely curable with antibiotics. A person with active TB will be put on four or more different antibiotics for at least six months. Taking several different drugs does a better job of killing the bacteria and prevents the bacteria from becoming resistant to the drugs. It is important to take the medication as prescribed by the doctor until the complete course is done. Failure to do so will result in a patient having a relapse of the disease and becoming symptomatic and infectious once again. It may result in a multi-drug resistant form of the disease. When the medication is taken properly, a patient is no longer contagious after three weeks of treatment. Depending on their risk factors, a person with a latent case of TB may need to go on antibiotics to prevent the development of active TB disease, This is a decision that should be made with the advice of a TB specialist. 

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Medications used to treat TB include:

 • Isoniazid (INH) • Rifampin • Pyrazinamide

 • Ethambutol • Streptomycin 

 

If dormant TB Infection is indicated by a normal Chest X Ray, treatment is voluntary and usually involves taking 2 pills (an antibiotic and a vitamin) for 9 months. Once started the series needs to be completed to prevent the formation of antibiotic resistant TB. The full treatment of TB infection will kill the dormant germs and prevent the development of active TB later in life. The medicines used to treat Tb are strong and can sometimes affect the liver of those taking TB therapy, especially if they are over the age of 35 or have a history of alcohol abuse. 

Paperwork Required

1. OC Public Health Communicable Disease Exposure Form (policy 330.96) with Fire incident number on top. Should be faxed while still in the hospital Fax: (714) 564-4050 per county policy must be received within 7 calendar days

 

OC Public Health Communicable Disease Exposure Form

1. The City “Report of Employee Injury” form

2. Medical Service Order- RM -67 (when medical care is required)

3. Sharps Injury Log

 

Post Exposure Follow-up:

If you are exposed to a person with active pulmonary TB it will be necessary for a previously negative person to have a TB skin test within a few days of exposure in order to rule out previous TB infection. If this test is negative, the exposed paramedic was not previously infected with TB, and therefore should have a repeat skin test three months after contact to allow their immune system time to recognize if it is now infected. If the skin test is negative at three months no further action is required. If the skin test is positive, the paramedic should consult a TB specialist. The paramedic should be instructed to have a chest x-ray and a sputum sample tested to rule out the development of active pulmonary disease before prophylactic medication is started. All those who had previously positive skin test should self-monitor for the development of signs and symptoms of TB disease and report to a doctor for assessment if any symptoms do develop.

 

If indicated by development of symptoms of active disease or a PPD skin test conversion, follow with an Infectious disease physician. Understand that once treatment begins, a patient ordinarily quickly becomes noninfectious; that is, they cannot spread the disease to others. During follow-up you must never deviate from your medication schedule. After you have successfully started treatment for tuberculosis, within a short time you are no longer able to pass it on to others. Re-infection in a normal healthy person is rare due to acquired immunity. However, in rare circumstances it may be possible to become re-infected, particularly if the immune system becomes compromised for any reason. If a person has resistant TB, he/she can remain infectious to others for a longer period of time.