#218 Five Things You Need to Know about TB

Join the Divas as they spotlight the latest CDC guidance and clinical insights on TB shaping infection control today. This episode breaks down what every dental professional needs to know to stay compliant, safe, and prepared. Walk away with the five top things you need to know along with current updates on TB.

• CDC Updates on TB: https://www.cdc.gov/tb-data/index.html
• TB statistics and outbreaks: https://www.cdc.gov/tb-data/2024-provisional/index.html

                                                 https://www.thecompliancedivas.com

Transcript

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SPEAKER_00 0:05

Welcome. I'm Leslie Cannum. I'm Mary Gavoni. I'm Linda Harvey. I'm Olivia Wan. And together we are the Compliance Divas.

SPEAKER_01 0:17

Welcome to the Compliance Divas Podcast. This is Linda Harvey. I will be your moderator for this episode. As the Compliance Divas, we bring clarity and simplicity to compliance. And in doing so, today we're going to talk about something that you normally don't think about on a top of mind in the dental practice, and that is TB or tuberculosis. But yet it's something that's very important to be aware of what's happening in our community and across the country. And actually, every time we use a disinfectant surface wipe, spray, or wipes, we should be thinking about TB because we're required to use surface disinfection products that actually kill TB. So it's in our practice that we don't think about it on an active, well, we'll play on that word, Mary, active state when it comes to TB. So, Mary, we've got today, Divas have five tips or five things we think every dental professional should know about TB. Can you jumpstart us on number one, please?

SPEAKER_00 1:11

Absolutely, Linda. The first is that the transmission risk of tuberculosis in a dental practice right now is low. And that has to do with the fact that even though there are cases, there are not a lot of cases, except in some certain areas, which we'll talk about. But it's very possible that your patients or a prospective patient that may come to your practice is has already been advised by a medical professional not to have any dental work done because of the aerosol and the potential risk of spreading tuberculosis. But if somebody is undiagnosed and we don't screen for symptoms of tuberculosis, then there could be a risk to dental professionals because of our aerosol generating procedures. And remember that both the CDC and OSHA say that aerosol generating procedures are the use of a high-speed handpiece, an airwater syringe, an ultrasonic scaler, an air polisher, and an air abrasion device. So any of those things can cause a risk of transmission. TB transmission, TB infection happens through exposure to an individual who has an active infectious TB case and is around 30 minutes or longer, which kind of fits that category for dental procedures. But we just need to make sure that we are understanding the difference, and we'll talk about this too, between someone who tests positive for TB and means they've either been exposed or they have latent TB and someone who has active TB.

SPEAKER_01 3:08

So thank you, Mary. Those are some great information for our listeners to bear in mind about TB. Our Diva Leslie couldn't be here today, but she wanted us to talk about two things in particular, and that is the TB protocols that are required. And what's the difference between active and latent TB? Because Mary, just as you talked about, are they in is the patient infective or not? It's important to know. So let's first talk about the written TB protocols. Both the CDC and even the ADA recommend that dental practices include a TB-specific infection. And as we know, many states have adopted the CDC guidelines into law in their State Dental Practice Act. So it's not something that's nice to have, it's something that you must have. Your written protocol, your plans, this should include uh screening of new hires, referral procedures if a patient has the signs and symptoms of TB, and team training in general. Now, clinically, when it comes to the difference between active and latent TB, we want to bear in mind that with latent TB, the bacteria is present, but it's not active.

unknown 4:09

Okay.

SPEAKER_01 4:09

And there's no symptoms, and that patient is not contagious. And the only way that's detected is through either a positive TB skin test, blood test, and sometimes a chest x-ray, but they could be normal as well. But only about five to ten percent of people with latent TB actually develop active TB if untreated. Whereas active TB is somebody with they have the bacteria and it's active and it's multiplying, and they have a persistent cough for three weeks or longer. They have chest pain from all the coughing. Um, and then maybe they're coughing up blood or sputum. So this is highly contagious because of the airborne droplets that Mary discussed with our aerosol generating procedures. So this type of patient needs immediate treatment. So it's important that we go when we go through our updates with medical history with patients, is to make sure we include those questions and not just simply ask the patient, has there been any changes in your medical history? But that's a whole nother topic on medical history, isn't it, Mary? So, Mary, can you um Diva Olivia was not able to join us today? So would you mind talking about the next two items in our five top five tips, please?

SPEAKER_00 5:20

Absolutely, Linda. And you alluded to the TB protocol for a practice, and that does include healthcare worker screening. The CDC, in its updated guidance, and we will put a copy of that in the show notes, has recommended that all new hires be screened for TB before they start working in a healthcare facility. And if they're found to have active TB, they cannot be working in that facility, even if they're working in the business office. They are not allowed to work in a healthcare facility. So somewhere between the time you agree to hire a new employee and they actually physically start working in the office, you need to send them either to an urgent care facility or to the county health department to have a tuberculin skin test. And the results of that could take up to 48 hours. So if that person again tests positive, there needs to be some more investigation as to why they test positive. Were they simply exposed to tuberculosis earlier in their life and they will always test positive, or do they have an active infection? And if they have an active infection, again, you cannot have them work in the office. So I'm gonna put my HR hat on for just a second and um talk about what this means. So with this requirement to screen for tuberculosis, you don't want to enter into an employment agreement with someone, you enter into a contingent offer of employment based on the results of their TB test. Because if you have an employment agreement with someone, yes, we're gonna start right away, and then you find out that they have TB and can't work, you may be obligated to pay for some unemployment benefits while they are unable to work. So we give a contingent offer of employment first based on results of the TB screening test. Now, I hear from practices all the time that haven't been doing this, and they say, well, what about the rest of the team? We have never done any TB screening tests, so what should we do? It wouldn't be a bad idea to either have somebody come to your practice or you send the employees to the health department just as a one-time thing. Then you've got some documentation that you don't have anyone with active TB just as a risk management tool. But there are no states that I'm aware of that require an annual TB test unless there happens to be TB testing in their particular area. But some of our listeners may be working in hospital settings. If you are an oral surgery assistant, maybe a pediatric assistant, and you do hospital cases, then you have to follow the hospital policy, which typically is an annual TB test. So we need to have that protocol. And in addition to that protocol, we need to make sure that we have appropriate PPE. If you remember back during the pandemic, we were told that we could provide emergency services for patients when our practices were shut down, only emergency services. So the same kind of protocol that you would want to protect from COVID-19 transmission applies to tuberculosis transmission. If you have a patient who is in pain, they have a toothache, they need they have an urgent problem, then you should be prepared with N95 respirators to wear that's going to give you the best protection against TB transmission for you. You absolutely need to use high-volume evacuation if you're going to create some aerosol. And you may want to think about scheduling that patient at the end of the day so that there aren't other patients in the reception area, and you minimize the amount of people that may be exposed. If they truly have an active case of TB, they would have been advised by their physician or the health department that they need to be wearing a face mask, and it's possible they may even be wearing a respirator. So we want to protect everyone that we can. Now, the good news is that there are shorter treatment times now as drugs to treat tuberculosis are getting better and better and better. Typically, it has been about a six-month treatment on uh either one antibiotic or a combination. Typically, when patients are treated, they start them out on three or four medications, and by process of elimination, they determine which one is going to work the best, and they keep that patient on that drug for about six months until they're no longer infectious. That time has been cut by a couple of months now. We're hearing and reading that there are four-month regimens for treatment, which is great, less time on the antibiotics. And so that makes it a little better. But keep in mind that you may have patients who have no idea that they have tuberculosis. They may think they just have a long cough and they've not seen, maybe they don't have healthcare coverage, so they've not seen a physician to be diagnosed. And so if you have someone come in to the practice that says they've had a prolonged cough, which the CDC says is three to four weeks or longer, if they've had a fever, um, if they've had unexplained weight loss, I'm waiting for that one. Um and if they have night sweats, a lot of women will report that they have that. But if they have a combination of both systems and symptoms, and they're coughing up blood. Coughing up blood should be an alarm bell that that for all of us that we don't treat this patient until we know why you are coughing up blood, because it could be something far more serious. So we screen, we send them for a medical evaluation before we treat, unless it's an emergency. And so we need to make sure that we're doing really, really good screening on patients with um potential symptoms of tuberculosis.

SPEAKER_01 12:15

Mary, that was phenomenal. So let's take them out and unpack some of the information because you had a lot of nuggets in that information. So, first to revisit your tip on HR, and I think that's a great awareness for all of our staff and team members that are listening to us. And it's I would liken it to the drug screen. So that way it's easy to remember if if your practice does drug screening, it's a similar thing. You offer contingent employment based on the results of the drug screen. So contingent employment based on the results of the TV test. That's beautiful. And I like the fact that now we we are learning that there are the regimen has been reduced even by two months. But let's also refer for our listeners to go back to about two weeks ago, perhaps, maybe it's last week, and listen to the podcast on antibiotic stewardship, because I think that really dovetails in what you talked about and listening to Dr. Marie Fluent, who's just phenomenal in the world of infection control, talk about what that means and what it involves. Because if a patient comes in or you're screening a patient and you've got potential symptoms, I think it's just it's really helpful for the team members to understand that. And it's also helpful for us to understand it individually in case us we ever contract TB or somebody we know or love. So just having that information is very powerful indeed. So Mary, before we offer any other tips, I'd like to go back and first I'm going to revisit the five things that everybody needs to know about TB and restate them. So transmission risk is low in dentistry, but it's not zero. Written TB protocols are required. Understanding what clinical clinically, what latent versus active TB matters and many means, and then updated screening for healthcare workers, definitely need to do that in your practice. And then the fact that number five, there's shorter, safer treatment regimens that are available now. So I encourage you to go back and look in your OSHA binder for your TB policies. Make sure it's up to date. And if you don't have one, now is the time to develop one. So, Mary, before we wrap up, do you have any other tips or suggestions you'd like to share?

SPEAKER_00 14:28

I do. And we will put these links in the show notes. Number one is to track the CDC's TB statistics pages because in the past couple of years there have been a significant number of cases of TB in the U.S. Kansas City, near where I live, had almost 80 cases, 79 cases, I believe, of active TB. And we've had some outbreaks in the past in California and a number in Florida and a number of other states. So you need to know. Also, check your county or state health department website to see if there are active cases of TB in your area. And also if you live in a university or college town, because colleges and universities have a lot of international students. And those international students, depending on where they're coming from, especially if they're coming from the Asian continent where TB infection rates are very high, they may have been exposed. And if they have been exposed to TB, they do have the potential over their lifetime to develop a TB infection. And the things that trigger it tend to be things like stress and what the amount of stress going to college in a foreign country where you maybe don't speak the language fluently, so that's a little stressful, could trigger that. We actually had a case when I lived in Michigan in the high school in my area where a young man who um emigrated to the US from India, part of that Asian continent, and he developed a TB infection while he was in the U.S. And he hid his symptoms because he was afraid that he would be sent back home and he didn't want to go. And unfortunately, this young man died at 17 years old, died from tuberculosis, which may have been treatable, but he was so worried that he would be um deported because of his TB infection that by the time he revealed his symptoms, it was too late to treat him. So that's sort of a tragic thing. So keep your finger on the pulse of the statistics to know whether your area is at high risk. Be prepared by having some N95 respirators on hand in case you need to treat a patient that has an emergency, and make sure you follow up on screenings for employees. Unless your state changes this, it's a one-time only.

SPEAKER_01 17:11

That's perfect, Mary. Thank you so much. And I was thinking about the transmission rates as well. Oftentimes when I'm on site with a practice, I will go ahead and check what's going on in their county and maybe even note it on the footer of their policy what year it was checked, what the rate was. So even though the policy itself is current, we're showing that we're checking the TB transmission rate on a regular basis. So I like to just add in a little bit of information. But those are some great reminders. We will make sure that those top five reminders and tips are in the show notes, as well as some of the links to the CDC that we spoke about. So thank you for joining the Compliance Divas today. We bring clarity and simplicity to compliance and helping you to navigate that regulatory world. So please don't forget to check out all the rich information in the show notes. And while you're there, scroll down and leave us a like or message. We'll see you next time.