TB patient in clinic, plz advise

[spiffycats]

Hey all last week we had a patient come in to clinic who had + PPD AND findings suggestive of TB on xray. Or office was very ill equiped for this. All we had were surgical masks which the girls rooming the patient did not even wear. Patient was sent to lab to get AFB x3 and no other precautions were taken. How is suspected tb handled in your clinic ? Do you carry n95 masks in your office? Do you make the patient and all staff involved wear one? Do you report somewhere and what measures do you take to minimize spread? Send to hospital? Thank you!

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[Doc_Mcstuffins]

Ruling out a patient for active tb needs evaluation in ER and admission to hospital for airborne precautions and work up.

 

[IMreshopeful]

If the patient has signs of active pulmonary TB they should not be evaluated in a clinic - send to ED where you can have a negative pressure isolation room and start the AFB rule out. Anyone exposed should get PPD or Quant-gold testing. This is not something you should try and handle in a clinic visit. The ID folks may disagree with me though.

 

[spiffycats]

If the patient has signs of active pulmonary TB they should not be evaluated in a clinic - send to ED where you can have a negative pressure isolation room and start the AFB rule out. Anyone exposed should get PPD or Quant-gold testing. This is not something you should try and handle in a clinic visit. The ID folks may disagree with me though.

how about if no symptoms of tb;? just positive ppd and suggestive xray findings

 

[Crayola227]

how about if no symptoms of tb;? just positive ppd and suggestive xray findings

the xray findings are how you dx that someone has active TB in the absence of sx... they get eval'd in the hospital and then likely started on tx

so yeah, a +ppd and +cxr buys you an eval

 

[chessknt]

Also a surgical mask on the patient will limit potential airborne spread. The n95 is needed when the patient isn't wearing one since the particle size gets smaller from evaporation. But these people are transported in elevators and in the hallways with a mask on.

 

[Elixir6]

Place N95 on the patient. That's how we transport them around the hospital for CXR etc...

 

[jdh71]

Place N95 on the patient. That's how we transport them around the hospital for CXR etc...

lol

why would THEY need the n95?

 

[jdh71]

TB work-up doesn't have to be done in a hospital and that might be the easiest way to get it done in many ways because the patient will be a more captive audience, but it does generally tie up an acute care bed really unnecessarily.

 

[IMreshopeful]

TB work-up doesn't have to be done in a hospital and that might be the easiest way to get it done in many ways because the patient will be a more captive audience, but it does generally tie up an acute care bed really unnecessarily.

It can be done at home too for sure. I think depends on how reliable the patient is. At my residency usually that was not the case

 

[Elixir6]

lol

why would THEY need the n95?

Correct - that's a mistake they just wear a surgical mask, not N95