Tuberculosis Risk and Control for Health Care Workers

Introduction

Tuberculosis (TB) is a serious health concern for many people, mostly in developing countries, but some populations have a higher chance of catching the disease than others (Lawlor, 2007). The population of interest here is health care workers, because they are always exposed to more diseases and problems than other populations are. They have higher instances of some diseases, and they put themselves at risk each day from the various types of germs they encounter. Some people who come to hospitals and doctors' offices are very sick and do not realize how serious their situation is or exactly what they have, and this is often true of tuberculosis because it is still rather unexpected in developed countries like the United States (Lawlor, 2007). Only around ten percent of people in the United States have tuberculosis, and most of them have a latent infection that does not produce any symptoms or cause them any problems (Lawlor, 2007).

There was a story several years back about a man who flew on a commercial airline from one country to another, knowing that he had TB. People all around him on the plane had to be tracked down and tested for the disease, but luckily he did not spread it to others. There was a lot of public outcry regarding the incident, however, because he risked the lives of many individuals. TB can be deadly, and once a person contracts it, it can be almost impossible to eliminate easily (Lawlor, 2007). There are some strains that are becoming very resistant to currently available antibiotics, and these strains indicate that TB is mutating and changing — meaning it may become more widespread and harder to control in the future. For the health care worker, that is a very serious and very real concern (Lawlor, 2007).

Agent of Disease

The disease is spread through coughing, sneezing, or saliva contact — similar to the flu or a cold (Kidder, 2004). Since that is the case, people who work around sick patients every day have to be more careful. The disease itself is caused by a bacterium, and it generally attacks the lungs (Kidder, 2004). It can, however, also attack the nervous system, the gastrointestinal system, or other areas of the body, depending on the person and how he or she reacts to the bacteria (Kidder, 2004). Skin, bones, and joints can also be affected by TB (Kidder, 2004).

Many people in developing countries carry the latent form of the bacteria but do not have symptoms. When they carry TB, they cannot pass it on to others unless their infection becomes active (Kidder, 2004). If the infection does become active, they will experience prolonged coughing — usually with blood in the sputum — along with trouble breathing, fatigue, weight loss, fever, night sweats, and other related symptoms (Kidder, 2004). The symptoms may differ, however, if the TB bacteria attack a part of the body other than the lungs.

Vulnerability of the Health Care Worker Population

For people who work in health care, tuberculosis is of heightened concern because they may be exposed to people who are not aware that they have the disease. The chance of exposure is much higher due to the volume of patients with health problems that these workers see each day. Since many people carrying TB do not present many symptoms, they would not be coming to health care workers specifically for this problem and would not be isolated or screened for it, at least not right away. Even people who come to doctors or hospitals with TB symptoms could also have something else, such as a bad cold or the flu, so many health care workers do not immediately consider the possibility that a patient has TB rather than something more common and routine.

Methods of Control

The best method of control is for people who are not infected with TB to stay away from those who are, until those individuals have been sufficiently treated and are no longer contagious. That is not always possible in health care settings, however. For those who must work around TB patients, careful precautions are essential. There is a vaccine used for children that works relatively well, but it does not work for adults, and adults are the ones who most often acquire the bacteria and suffer the consequences (Blumberg, Leonard, & Jasmer, 2005). Since adults cannot be reliably vaccinated for TB, health care workers should isolate those with active TB infections and should wear gloves, masks, and eye protection at all times when working with TB patients (Blumberg, Leonard, & Jasmer, 2005).

The more protected workers are from aerosolized infected droplets, the better their chances of avoiding infection (Blumberg, Leonard, & Jasmer, 2005). The key, of course, is to locate anyone with active TB and treat them promptly so that they do not infect more people. Those with latent TB should also be treated, but the situation is less urgent because they are not infectious and cannot transmit the disease to others simply by coughing or sneezing (Blumberg, Leonard, & Jasmer, 2005). Only around ten percent of latent TB infections ever progress to active ones that could spread the disease (Blumberg, Leonard, & Jasmer, 2005). Prevention and antibiotics remain the only recognized methods for treatment of TB (Blumberg, Leonard, & Jasmer, 2005).

Conclusion

It is clear that TB is serious and should not be taken lightly by health care workers or by others who may come into contact with TB-infected individuals. Approximately fifty percent of people who develop an active TB infection and are not treated properly die from it. Anyone who works in a health care setting is at increased risk simply because he or she is exposed to far more potential sources of infection than the general public. Without a reliable adult vaccine, prevention, testing, and prompt treatment remain the best strategies for keeping the rate of TB infection low.