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S Step 1 Conduct a TB Risk Assessmenttep 1 Conduct a TB Risk Assessment
Conduct a risk assessment for the entire facility
and for specific areas within the facility. The admission until acid-fast bacilli (AFB)
elements of the risk assessment are included specimens ordered;
below for complete information on how to con- AFB specimens ordered until AFB
duct the assessment. Perform a follow-up risk specimens collected;
assessment at the intervals indicated by the most AFB specimens collected until AFB
recent risk assessment [CDC 1994, Figure 1, smears performed and reported;
Table 2]. Determine who must wear a respirator AFB specimens collected until cultures
and be included in the program. performed and reported;
AFB specimens collected until species
TABLE 1. Elements of a risk assessment identification conducted and reported;
for tuberculosis (TB) in health care facili- AFB specimens collected until drug-
ties (Reprinted from [CDC 1994, page 8]) susceptibility tests performed and
reported;
1. Review the community TB profile admission until TB isolation initiated;
(from public health department data). admission until TB treatment initiated;
and duration of TB isolation.
2. Review the number of TB patients
who were treated in each area of the Obtain the following additional information:
facility (both inpatient and outpatient).
(This information can be obtained by Were appropriate criteria used for dis-
analyzing laboratory surveillance data continuing isolation?
and by reviewing discharge diagnoses or Did the patient have a history of prior
medical and infection-control records.) admission to the facility?
Was the TB treatment regiment
3. Review the drug-susceptibility pat- adequate?
terns of TB isolates of patients who were Were follow-up sputum specimens
treated at the facility. collected properly?
Was appropriate discharge planning
4. Analyze purified protein derivative conducted?
(PPD)-tuberculin skin-test results of
health care workers (HCWs), by area or 6. Perform an observational review of TB
by occupational group for HCWs not infection control practices.
assigned to a specific area (e.g., respira-
tory therapists). 7. Review the most recent environmental
evaluation and maintenance procedures.
5. To evaluate infection-control param-
eters, review medical records of a sample Copies of the Morbidity and Mortality Weekly
of TB patients seen at the facility. Report (October 28, 1994/Vol. 43/No. RR-13)
entitled "Guidelines for Preventing the Transmis-
Calculate intervals from: sion of Mycobacterium tuberculosis in Health Care
admission until TB suspected; Facilities, 1994" may be obtained by calling
admission until TB evaluation 1-800-843-6356 or is available through the CDC
performed; homepage at http://www.cdc.gov.
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