[Table of Contents]

Volume: 22S1 • April 1996

Guidelines for Preventing the Transmission of Tuberculosis in Canadian Health Care Facilities and Other Institutional Settings

IV. TB MANAGEMENT PROGRAM

G. Educational and Counselling Programs for HCWs

The TB management program should designate one or more staff members to be responsible for HCW educational and counselling programs related to TB. For the purposes of this section, this individual will be referred to as the occupational health practitioner.

Educational Programs

All HCWs should receive education about facility and workplace-specific TB management measures. Educational programs should be tailored to the work environment, the HCW's occupation, and type of activities performed. Occupational health and infection control personnel, as well as local managers, should be involved in designing the program.

Education of HCWs New to the Facility

All HCWs should participate in a TB education program, ideally during their orientation period or within the first 3 months of working at the health care facility. The program should include information about the following:

• TB transmission, pathogenesis, presenting symptoms and signs, and groups at higher risk of having active TB; (The Canadian Thoracic Society has a selection of slides and a speakers bureau. (National Office, Suite 508, 1900 City Park Drive, Gloucester, ON, K1J 1A3. Phone: (613) 747-6776, Fax: (613) 747-7430.)

• the potential for occupational exposure to TB in the facility (see Section IV.B) and evaluation of exposure events (see Section IV.D.8);

• workplace-specific and facility-specific infection control policies and TB management policies;

• the rationale for isolation precautions for patients with suspected or confirmed infectious TB and the need to adhere to these;

• the proper use of masks;

• how to report individuals with suspected TB;

• the purpose of pre-placement, post-exposure and ongoing regular TST programs;

• the need for prompt medical evaluation if the HCW develops symptoms suggestive of active TB or is found to have a new positive TST;

• the importance of reporting changes in HCW health status (e.g., the development of new positive TST or active TB) to occupational health;· the role of medical therapy following TST conversion or the development of active TB;

• the potential increased risk immunocompromised (HIV and other conditions) HCWs have of acquiring TB infection after exposure to an individual with active TB and the known increased risk immunocompromised individuals have of developing active TB after they become infected with M. tuberculosis;

• the health care facility's policy on work reassignment for HCWs who are immunocompromised; and

• how the confidentiality of information obtained in HCW TB screening and surveillance programs will be maintained.

Ongoing Education of HCWs

HCWs should receive ongoing and updated information about the transmission of TB, as required. Education may be provided in conjunction with ongoing HCW screening and surveillance programs.

Counselling Programs

Counselling should be offered to all HCWs who have a positive TST (see Section IV.D.7). Individuals who have a negative TST and are immunocompromised should also be counselled because these individuals may be unable to mount a positive TST (see Appendix B). All HCWs at risk for immunodeficiency disorders (e.g., HIV infection, renal insufficiency, lymphoma, etc.) should be counselled regarding the risks of TB exposure in their work environment and preventive strategies. Job transfer is seldom necessary but may be considered in selected instances of high risk⁽²⁶⁾.

Periodic Updates of Individual and Group Health Status

HCWs participating in surveillance programs should be regularly informed of the results of TB surveillance program. This information may be best shared during visits for ongoing surveillance or during periodic program updates (see Section IV.A).

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