Additional In Services 2

Incidence of Tuberculosis

Tuberculosis is not evenly distributed among the population. The highest incidence is found in: African Americans, American Indians, Asians, Pacific Islanders, prison inmates, alcoholics, and IV drug users. Others include persons with risk factors such as HIV, or ones receiving chemotherapy. Persons over 65 constitute a large number of TB infections as well. They account for 85% of nursing home residents, where there could be a large concentration of infected persons, who are immune suppressed, and live within close proximity.

SPREAD OF INFECTION

The organism causing the disease, Mycobacterium tuberculosis, is carried by airborne droplets, and is highly contagious. The bacilli become established in the alveoli of the longs and spreads throughout the body. The disease may take up to 10 weeks to fully develop. The initial infection may rapidly progress to a severe clinical illness in at-risk patients. For those who do not carry the above-mentioned risk factors, the disease may take months even years to replicate symptoms of the disease. There is rapid progression of TB with patients having HIV. Some procedures utilized in health care may also contribute to the spread of TB: abscesses, suctioning. Resp. therapy. Needle sticks may spread TB.

RISK FOR HEALTH CARE WORKERS

The risk of exposure or contracting of the disease is higher in at-risk areas such as: E.R., ICU, clinics, nursing homes, in-field workers. Facilities should ensure that appropriate TB prevention and control measures are taking to residents and staff to protect the spread of the disease. The following activities should take place: surveillance of staff, residents, and the facility; containment of the infection, with the appropriate course of treatment under supervision; assessment and monitoring of the disease progress, and of the facility infection control policies; education to residents, families, staff, visitors to ensure the compliance with the need for prevention and therapy.

DIAGNOSIS

Symptoms are: persistent cough, weight loss, loss of appetite or fever. This would be difficult to diagnose with positive HIV. The PPD Skin Test should be given to all health care workers yearly. A positive skin test does not mean that the person has TB, but a follow-up chest x-ray should be done. A sputum test may also be required. Residents of long-term care facilities should also be tested yearly. When TB is confirmed, the Health Dept. must be notified.

CONTAINMENT

Patients diagnosed with TB must begin medication immediately. When the positive diagnosis is made, and the patient exhibits symptoms, isolation under negative pressure is necessary. Repeat chest x-rays and sputum smears are obtained for follow-up. Persons in contact with the TB patient are at risk for contacting the disease, and must be monitored. Persons with a positive skin test, and negative chest x-ray should be monitored. If those persons have been exposed to an individual with TB, medications should be maintained for 6 months.

SUMMARY

Tracking the status of the patient with TB is essential. Both the therapy regimen and monitoring of testing must be included in the facilities’ system. State and local health departments, will assist in developing policies to train, contain, and maintain TB prevention. The incidence of TB is rising among residents in healthcare facilities. Steps must be taken to recognize, diagnose, treat and test individuals who have been exposed, and those who are at risk.

Ulcer In-services

Preventing pressure ulcers:

Pressure ulcers are also called bedsores and pressure sores. They can form when muscles and soft tissue press against a surface such as a chair or bed. This pressure cuts off blood supply to a particular area on the body. Lack of blood supply can cause the skin tissue in this area to die. When this happens, a pressure ulcer may form.

Clients have a risk of developing a pressure ulcer if they:

• Spend most of their day in a bed or a chair.
• Are overweight or underweight.
• Are not able to control your bowels or bladder.
• Have decrease feeling in an area of your body.
• Spend a lot of time in one position.

Care for individuals susceptible to ulcers:

Check their body every day from head to toe. Pay special attention to the areas where pressure ulcers often form. These are:

• Heels and ankles
• Knees
• Hips
• Spine
• Tailbone area
• Elbows
• Shoulders and shoulder blades
• Back of your head
• Ears

Call the doctor or nurse if you see early signs of pressure ulcers. These are:

• Skin redness
• Warm areas
• Spongy or hard skin
• Erosion of the top layers of skin or a sore

Treat skin gently to help prevent pressure ulcers.

• When washing, use a soft sponge or cloth. Do not scrub hard.
• Use moisturizing cream and skin protestant’s on the skin every day.
• Clean and dry areas underneath breasts and around groin.
• Does not use talc powder or strong soaps.

If a client uses a wheelchair:

• Have the doctor or physical therapist check the fit once or twice a year.
• If there is a gain in weight, ask the doctor or physical therapist to check how the client fits in the wheelchair.
• If the feels pressure anywhere, have the doctor or physical therapist checks the wheelchair.

Sit the client on a foam or gel seat cushion that fits their wheelchair. Do NOT sit on donut-shaped cushions.

Shift your client’s weight in the wheelchair every 15 - 20 minutes. This will increase blood flow and take pressure off certain areas:

When the client is in bed

Use a foam mattress or one that is filled with gel or air. Place pads to absorb wetness to help keep skin dry. Use a soft pillow or a piece of soft foam between parts of the body that press against each other or against the mattress.

When to Call the Doctor

• You notice a sore, redness, or any other change in the client’s skin that last for more than a few days or becomes painful, warm, or begins to drain pus.
• The wheelchair does not fit.

Disaster Inservice

Recent disasters have become the hard teacher. Emergency preparedness may be the difference between dying and surviving an emergency. Are you prepared for an emergency if it were to happen right now? There are different types of disasters:

Natural:

Being hurricanes, tornadoes, thunder storms, flash flooding, high winds, hail, and severe winter weather;

Man Made Disasters:

War, toxic spills, riots or civil disorders, nuclear plant melt down, and terrorism;

Technological Failure Disasters:

Electrical outage, communication failure, heating and cooling failures.

To prepare one need to know about what type of disasters are more likely to occur in your area you live. Know your community warning system: radio, TV, word of mouth. During times of emergency basic items are needed: water, food, medications, clothing, bedding, and first aid supplies and should have at least a 3 day supply of each on hand for each person in the household. It is also recommended that a gallon of water per person of household be available. Filing a bathtub, sink or washing machine may be needed. A 3 day supply of canned ready to eat foods. Call electrical company in advance to inform if any oxygen or vent equipment use in the home in case of electrical outage as to limit outage time. If possible have a generator available and ready to operate. Disasters are going to happen but knowing how to prepare will help you survive.

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