Mantoux skin test/CDC PHIL
In the U.S., the chances are that tuberculosis isn’t on your mind a lot. Most of us focus on TB only when we have a patient on airborne precautions—or when we’ve been exposed to TB at work.
Globally, TB was one of the top 10 causes of death in 2015. In the U.S., after a spike in cases early in the HIV epidemic, the incidence of TB has fallen to about three cases per 100,000 people. In TB-endemic countries, incidence rates run into hundreds per 100,000. But with TB elimination defined as a rate of less than one case per million people, we are far from eradicating this disease in the U.S. In fact, the number of TB cases in the U.S. rose slightly from 2014 to 2015.
Also, of course, nurses often work with people who are at high risk of acquiring TB—transplant recipients, others who are immunocompromised, people with HIV or certain cancers, those who are refugees or homeless—increasing our own risk for the disease as well. Therefore, the low overall U.S. incidence rate doesn’t reflect the experience (or risk) of most nurses. (And if you are “PPD positive,” click here for some reminders about what that should mean to you as a nurse: “Nurses and Latent TB Infection.”)
Nurses in virtually every setting can play a critical role in case finding by recognizing those at high risk for the disease and facilitating testing. And excellent infection control practices can contain transmission. Fortunately, newer testing methods and shorter treatment regimens make these tasks easier and help ensure treatment of more people with latent as well as active TB.
Read about new recommendations for TB screening and treatment in “Tuberculosis: A New Screening Recommendation and an Expanded Approach to Elimination in the United States” in this month’s AJN.
I do agree that in the United States, TB is not on our minds often though in 2015 it was one of the top ten causes of death globally. Many immunocompromised individuals are at risk for tuberculosis so it makes sense that a vulnerable population would be the homeless and refugees. The blog did not really go into the prevention of tuberculosis. Once exposed to TB and unaware, it can easily be passed on through the air. Infection control is important along with basic precaution of washing hands, covering the mouth.
While the prevalence of death resulting from tuberculosis has significantly decreased in the United States, complete elimination of tuberculosis is unlikely to occur within this century. As a nurse, I understand the imminent role that myself and all nurses play in screening and early detection, as well providing patient education. It is equally as important to prevent the spread of tuberculosis to those populations most at risk for contracting this air-borne disease. As a pediatric nurse, I take all necessary precautions to protect my young patients and myself by using the proper PPE even before a definitive diagnosis has been made. This is incredibly important with patients under the age for routine TB testing, who can still fall prey to tuberculosis.