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SESSION 6:SESSION 6:Field Safety and Infection Field Safety and Infection ControlControl

DOT Curriculum Session 6 2

Transmission of Transmission of M. TuberculosisM. Tuberculosis

1. TB is transmitted through the air by a 1. TB is transmitted through the air by a person with TB disease of the lungs person with TB disease of the lungs or larynx or larynx

2. Droplets containing 2. Droplets containing M. tbM. tb are are released into the air by coughing, released into the air by coughing, sneezing, talking, or breathingsneezing, talking, or breathing

DOT Curriculum Session 6 3

Transmission of Transmission of M. Tuberculosis M. Tuberculosis (2)(2)

3. For TB transmission to occur, 3 3. For TB transmission to occur, 3 things are required: things are required:

• a TB patienta TB patient

• an air pathan air path

• a susceptible persona susceptible person

DOT Curriculum Session 6 4

Transmission of Transmission of M. Tuberculosis M. Tuberculosis (3)(3)

4.4. Characteristics of TB transmission Characteristics of TB transmission include the following:include the following:

• a single TB droplet may be able a single TB droplet may be able to cause infection to cause infection

• it is relatively difficult to become it is relatively difficult to become infected with TBinfected with TB

• the source of TB infection may the source of TB infection may not be identified not be identified

DOT Curriculum Session 6 5

Transmission of Transmission of M. Tuberculosis M. Tuberculosis (4)(4)

The chances of TB transmission The chances of TB transmission occurring depend on three factors: occurring depend on three factors:

1. Source patient1. Source patient

2. Exposure time2. Exposure time

3. Environment 3. Environment

DOT Curriculum Session 6 6

Work Practice Controls Work Practice Controls

When transporting patients:When transporting patients:

1. Provide and instruct the patient to 1. Provide and instruct the patient to wear a surgical mask over his/her wear a surgical mask over his/her mouth and nose. The patient should mouth and nose. The patient should not wear a respirator not wear a respirator

2. Have enough surgical masks available 2. Have enough surgical masks available for the entire journey. Have patient for the entire journey. Have patient change masks when wet or torn change masks when wet or torn

DOT Curriculum Session 6 7

Work Practice Controls Work Practice Controls (2)(2)

When transporting patients:When transporting patients:

3.3. Let the facility or department where Let the facility or department where you are going know in advance that you are going know in advance that the patient is arriving. Advise the the patient is arriving. Advise the facility or department in advance of the facility or department in advance of the appropriate precautions and treatment appropriate precautions and treatment needs of the patientneeds of the patient

DOT Curriculum Session 6 8

Work Practice Controls Work Practice Controls (3)(3)

When transporting patients:When transporting patients:

4. Wear an N-95 respirator during the 4. Wear an N-95 respirator during the entire journey entire journey

5. Drive additional passengers and staff 5. Drive additional passengers and staff members in a separate vehicle members in a separate vehicle

6. Set ventilation controls to the fresh air 6. Set ventilation controls to the fresh air or vent setting, rather than the or vent setting, rather than the recirculation setting recirculation setting

DOT Curriculum Session 6 9

Work Practice Controls Work Practice Controls (4)(4)

When transporting patients:When transporting patients:

7. Set any fan(s) to a high setting7. Set any fan(s) to a high setting

8. Open as many windows as possible8. Open as many windows as possible

9. Leave the vehicle unoccupied with the 9. Leave the vehicle unoccupied with the windows open for at least an hour windows open for at least an hour after the end of the journey after the end of the journey

DOT Curriculum Session 6 10

Work Practice Controls Work Practice Controls (5)(5)

When working in institutions at high When working in institutions at high risk for TB transmission:risk for TB transmission:

1. Conduct as much work as possible in 1. Conduct as much work as possible in non-patient/resident care areasnon-patient/resident care areas

2. Keep doors and windows open as 2. Keep doors and windows open as much as possiblemuch as possible

DOT Curriculum Session 6 11

Work Practice Controls Work Practice Controls (6)(6)

When working in institutions at high When working in institutions at high risk for TB transmission:risk for TB transmission:

3. Give several tissues to a potentially 3. Give several tissues to a potentially infectious person and instruct him/her infectious person and instruct him/her to cover his/her nose and mouth when to cover his/her nose and mouth when coughing or sneezingcoughing or sneezing

DOT Curriculum Session 6 12

Work Practice Controls Work Practice Controls (7)(7)

When conducting home visits:When conducting home visits:

1. Explain the precautions taken to 1. Explain the precautions taken to prevent transmission of TB and ask prevent transmission of TB and ask for patient’s cooperation for patient’s cooperation

2. When appropriate, conduct the visit 2. When appropriate, conduct the visit outdoors outdoors

DOT Curriculum Session 6 13

Work Practice Controls Work Practice Controls (8)(8)

When conducting home visits:When conducting home visits:

3.3. Give the patient several tissues and Give the patient several tissues and instruct him/her to cover his/her nose instruct him/her to cover his/her nose and mouth when coughing or and mouth when coughing or sneezing sneezing

4.4. Open a window and sit near it if Open a window and sit near it if indoorsindoors

DOT Curriculum Session 6 14

Work Practice Controls Work Practice Controls (9)(9)

When conducting home visits:When conducting home visits:

5.5. Conduct the visit as efficiently as Conduct the visit as efficiently as possible in order to reduce exposure possible in order to reduce exposure time time

DOT Curriculum Session 6 15

Work Practice Controls Work Practice Controls (10)(10)

When assisting a patient in the When assisting a patient in the collection of sputum specimens in collection of sputum specimens in the field:the field:

1.1. If possible, avoid being present during If possible, avoid being present during sputum induction or explain the sputum induction or explain the precautions to be taken and ask for precautions to be taken and ask for cooperation cooperation

DOT Curriculum Session 6 16

Work Practice Controls Work Practice Controls (11)(11)

When assisting a patient in the When assisting a patient in the collection of sputum specimens in collection of sputum specimens in the field:the field:

2.2. Take patient outside or to sputum Take patient outside or to sputum induction room, if availableinduction room, if available

3.3. Wear a powered air–purifyingWear a powered air–purifyingrespirator respirator

DOT Curriculum Session 6 17

Review QuestionsReview Questions

1.1. What are 5 ways to reduce personal What are 5 ways to reduce personal safety hazards in the field?safety hazards in the field?

2.2. What are 2 factors that affect the risk What are 2 factors that affect the risk of of M. tbM. tb transmission? transmission?

DOT Curriculum Session 6 18

Review Questions Review Questions (2)(2)

3.3. What are 3 ways TB control staff can What are 3 ways TB control staff can protect themselves and others from protect themselves and others from exposure to active, infectious TB? exposure to active, infectious TB?

4.4. What are 3 requirements for using What are 3 requirements for using respirators (masks) properly?respirators (masks) properly?