ob nurse at local hospital diagnosed with active...
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Case StudyAngela Gray, BSN, RN
Berkeley County Health Dept.304‐263‐5131
Angie.K.Gray @wv.gov
OB Nurse at Local Hospital Diagnosed With Active Tuberculosis
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The Importance of Tuberculosis Testing for Healthcare Workers
Detect early conversion Detect possible TB casePrevent possible exposure
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Index Case History
40 year old white femaleU. S. bornCough, fatigue, fever and night sweatsNo Hx of smoking, drugs, or alcohol abuse No Hx of HIV
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Index Case Risk Factors
Healthcare workerRecent international travelRecent adoption of a foreign‐born child with LTBIAnnual employment TB screening not conducted
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Reasons for Delayed Diagnosis
•Misdiagnosed in ER (pneumonia) April 2007•Prescribed Levaquin/masked symptoms•Delayed TB testing•CXRs June, July and October 2007 “unresolvingpneumonia”•CXR and CT Scan November 2007 read as normal
•State TB employed physician later found RLL infiltrate
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Delayed TreatmentTST was obtained 10‐24‐07 ‐ 17mm positive resultBronch performed 11‐14‐07Prescribed 4 drug therapyAFB smear negative
discontinued 4 drug therapy after 7 dayscleared patient to return to work
Culture positive December 2, 2007Reported to Health Department at this point
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Contact Investigation611 Total Contacts Tested
FamilyPatientsHospital Staff
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TST on 146 infants
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Contact Investigations Findings
2 Positive tests1 baby/completed treatment1 adult/did not complete treatment
To neighboring county for treatmentIntolerant of meds due to breast cancer treatment
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Importance of Contact Investigation
Prevent potential future case of TB Prevent potential case of TB Meningitis in InfantsIdentify LTBI casesIdentify any further active cases
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Hospital Cooperation
Provided CXRs for the infantsProvided LFTs for the infantsProvided computer/monitor for CXR (disc) readings at the LHDMailed notification letters to TB contactsJoint press release with LHD case at the hospital
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OutcomeDeveloped Partnership between LHD and HospitalEducation for hospital staffHospital staff now recognizes warning signs of TB infectionPhysicians more likely to follow protocol to detect and prevent additional exposurePotential cases are now reported as soon as the diagnostic process begins
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