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HHE Search Results
62 HHE reports were found based on your search terms. Reports are listed in order of year published with the most recently published reports listed first.
Year Published and Title
(2021) Mycobacterium tuberculosis (TB) transmission from Asian elephants to zoo employees. (Click to open report) The National Institute for Occupational Safety and Health (NIOSH) received a request for a Health Hazard Evaluation from the chief administrative officer of a zoo and aquarium. The request concerned transmission of Mycobacterium tuberculosis (TB) to zoo employees who were working with and around Asian elephants. The 29-acre zoological park was operated by a municipal corporation overseeing parks and recreation services. The zoo's two female Asian elephants were housed in the elephant barn, which... (Click to show more)The National Institute for Occupational Safety and Health (NIOSH) received a request for a Health Hazard Evaluation from the chief administrative officer of a zoo and aquarium. The request concerned transmission of Mycobacterium tuberculosis (TB) to zoo employees who were working with and around Asian elephants. The 29-acre zoological park was operated by a municipal corporation overseeing parks and recreation services. The zoo's two female Asian elephants were housed in the elephant barn, which was an approximately 3,875 square foot, two-story building with elephant housing on the lower level and employee workspace and animal food storage on the upper level. Adjacent to the elephant barn was a large yard where the elephants were released daily for exercise. The elephant barn and yard are referred to as the "elephant area" for the purpose of this report. At the time of the site visit, approximately 40 employees comprised of elephant keepers, veterinary staff, and facilities and operations staff worked in the barn. Before this outbreak, volunteers worked in the elephant area, but once TB was identified, no volunteers were allowed in the barn and this policy continues to be implemented to limit the number of people potentially exposed to TB. Elephant barn employees participated in annual TB screening conducted offsite at an occupational health provider recommended by the zoo or their primary care provider with either a tuberculin skin test (TST) or blood test (interferon-gamma release assay [IGRA]). In September 2019, eight of twelve zoo employees who worked primarily in the elephant area tested positive for TB infection using IGRA tests; these employees were evaluated for TB and all received a diagnosis of LTBI and were started on LTBI treatment. All employees diagnosed with LTBI had tested negative by TST in 2018. In light of these newly diagnosed infections in employees, both elephants were tested and found to be reactive on the serologic multiantigen print immunoassay (MAPIA) test. Additionally, Mycobacterium tuberculosis DNA was detected by quantitative polymerase chain reaction (qPCR) performed on trunk wash samples obtained in September 2019. In November 2019, TB trunk wash cultures isolated M. tuberculosis from specimens collected from both animals, indicating that both elephants had infectious TB disease. One of the elephants had a long history of being MAPIA-reactive, but the other elephant was newly positive. Both elephants were considered geriatric. For these reasons, the zoo administration believed that the elephants were the probable source of infection for the eight elephant barn employees diagnosed with LTBI in September 2019. In November 2019, a NIOSH team and member of the Centers for Disease Control and Prevention's Division of Tuberculosis Elimination visited the zoo. We completed the following activities during our evaluation: 1. Toured the elephant area (including the elephant barn and yard) and observed workplace practices, including personal protective equipment (PPE) use when working with elephants and in the elephant area. 2. Assessed the elephant barn ventilation system. 3. Conducted voluntary, confidential interviews with 19 employees, including elephant keepers, veterinary staff, and facilities and operations staff. 4. Reviewed the TB exposure control plan for employees including the respiratory protection program, fit testing plan, and draft employee TB surveillance protocol. 5. Met with county and state health department representatives. Our Key Findings: 1. Employees who primarily worked in the elephant area and had contact with the elephants were more likely to test positive for TB infection. 2. At the time of the health hazard evaluation, the zoo had a respiratory protection program and employee TB surveillance program; however, upon review both could be improved. 3. One ventilation system serviced both the elephant housing area and office space in the elephant barn, allowing air from the elephant housing area to enter employee workspaces. 4. Employees needed more information on TB risk and prevention. Our Recommendations: 1. Reduce potential employee exposure to M. tuberculosis. 2. Implement a respiratory protection program and require all employees and volunteers at risk of TB exposure to participate in the zoo's respiratory protection program. 3. Institute an updated TB surveillance program and require that all employees and volunteers potentially exposed to TB participate in the zoo's TB surveillance program. 4. Provide a ventilation system for areas on the upper floor of the barn including the entrance hallway, locker room, restroom, office, and kitchen areas that is separate from the ventilation system for the elephant housing area. 5. Ensure employees understand the hazards associated with working with TB-positive animals and how to protect themselves. 6. Ensure standard procedures for PPE use are clearly identified, communicated to employees, and enforced by supervisors.
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(2018) Potential employee exposures to Mycobacterium tuberculosis in a zoo's elephant exhibit. (Click to open report) In April 2017, the National Institute for Occupational Safety and Health received a health hazard evaluation request from the occupational health and safety manager at a zoo. The request stated concerns about employee exposures to elephants with active tuberculosis (TB) disease. In May 2017, we conducted a site visit and toured the elephant facility, interviewed employees who worked with elephants, observed work practices, evaluated the zoo's occupational health protocols, and assessed the venti... (Click to show more)In April 2017, the National Institute for Occupational Safety and Health received a health hazard evaluation request from the occupational health and safety manager at a zoo. The request stated concerns about employee exposures to elephants with active tuberculosis (TB) disease. In May 2017, we conducted a site visit and toured the elephant facility, interviewed employees who worked with elephants, observed work practices, evaluated the zoo's occupational health protocols, and assessed the ventilation systems in the elephant barn and indoor exhibit. We also reviewed occupational health records provided by the zoo's occupational health provider. We returned in July 2017 and participated in a TB meeting hosted by the zoo at the request of the local health department. After reviewing the occupational health protocols, we determined that the zoo's Tuberculosis Exposure Plan needed improvement, specifically to clearly define employee exposure classifications. We also found that the Tuberculosis Monitoring Program and Respiratory Protection program needed better record keeping. We observed employees properly donning and doffing personal protective equipment. However, we also observed employees not wearing N95 respirators properly. We interviewed seven employees who worked with elephants. No employees voiced concerns about their health or working around elephants with TB disease. The ventilation systems assessment confirmed that the ventilation within the elephant barn and indoor exhibit were adequate. We recommended that the zoo assign a designated person to ensure adequate record keeping for the Respiratory Protection Program and Tuberculosis Monitoring Program. We recommended to clearly define parts of the Tuberculosis Exposure Control Plan and ensure employees adhere to the Respiratory Protection Program. We also recommended that N95 respirators be available to any employee who works with the elephant herd.
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(2015) Potential employee exposures to Mycobacterium tuberculosis at an elephant refuge. (Click to open report) The Health Hazard Evaluation Program received a technical assistance request from officials at a state health department. They asked us to evaluate the ventilation systems, work practices, and personal protective equipment used by employees at an elephant refuge. A state investigation found evidence of elephant to employee transmission of Mycobacterium tuberculosis in nine employees from 2006-2009. The refuge occupied about 2,700 acres and had four barns housing elephants. Most of the roughly 30... (Click to show more)The Health Hazard Evaluation Program received a technical assistance request from officials at a state health department. They asked us to evaluate the ventilation systems, work practices, and personal protective equipment used by employees at an elephant refuge. A state investigation found evidence of elephant to employee transmission of Mycobacterium tuberculosis in nine employees from 2006-2009. The refuge occupied about 2,700 acres and had four barns housing elephants. Most of the roughly 30 employees worked on the refuge grounds around elephants, but some administrative employees worked in a building that was outside the refuge. Several employees lived on the refuge grounds. We made four site visits from 2010 to 2012. During these visits, we met with refuge managers and employees; reviewed employee health records; observed workplace conditions, work processes and practices; and evaluated ventilation systems in barns by measuring pressure differences and by using smoke and tracer gas. On the basis of our findings and recommendations, refuge managers improved the employee screening program for tuberculosis (TB) disease and the respiratory protection program, installed new ventilation systems, and sealed wall openings in the quarantine barn, among other changes. We found that these changes better controlled potential employee exposures to Mycobacterium tuberculosis. Additional recommendations we made in this report include: (1) treating all elephants with active TB disease, (2) turning on the barns' exhaust fans 15 minutes before employees enter, and (3) checking air pressure indicators when elephants with known or suspected TB disease are present. We recommended employees (1) get a tuberculin skin test at least every year if their last skin test was negative or they had not been tested, (2) get a medical evaluation for TB disease every year if they had a positive tuberculin skin test in the past, (3) report ventilation system problems to their supervisor, and (4) wear a respirator when working within 25 feet of an elephant with confirmed or suspected TB disease and when entering the isolation or quarantine barn elephant stall areas, even if elephants are not present.
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(2014) Environmental controls at a faith-based homeless shelter associated with a tuberculosis outbreak - Texas. (Click to open report) On March 21, 2013, the National Institute for Occupational Safety and Health (NIOSH) received a request for technical assistance from the Chief Epidemiologist of the Dallas County Department of Health and Human Services, on behalf of the Executive Director of a large faith-based homeless shelter in Dallas, Texas, which was one of two shelters linked to an ongoing tuberculosis outbreak among homeless people in the Dallas area. The request asked NIOSH to assess the heating, ventilation, and air-co... (Click to show more)On March 21, 2013, the National Institute for Occupational Safety and Health (NIOSH) received a request for technical assistance from the Chief Epidemiologist of the Dallas County Department of Health and Human Services, on behalf of the Executive Director of a large faith-based homeless shelter in Dallas, Texas, which was one of two shelters linked to an ongoing tuberculosis outbreak among homeless people in the Dallas area. The request asked NIOSH to assess the heating, ventilation, and air-conditioning (HVAC) systems and make recommendations to improve overall environmental controls at the shelter. During an on-site evaluation of the homeless shelter in June 2013, we collected physical and ventilation measurements in all key areas of the facility. We focused on areas where shelter guests typically congregate or spend significant amounts of time. We recorded the make and model number of air-handling units (AHUs) providing air to the facility, and visually inspected the units, when possible. We also measured the air flow rate through all supply diffusers and return grilles. Over the last two decades, the shelter has acquired all of the pieces of a former commercial office building. Thus, the shelter inherited HVAC equipment from various manufacturers. We were able to identify ventilation quipment from at least 13 different manufacturers during our assessment (see Table 1). Air-handling units ranged from newer, well maintained systems to old, inoperable systems. Ventilation filters were often missing or installed in incorrect configurations. Certain aspects of the ventilation systems' operation could potentially contribute to airborne disease transmission among shelter guests. Some areas of the shelter were not being served by mechanical ventilation during our visit, because various AHUs were not functional. Additionally, it appeared the AHUs were not providing adequate outdoor air to the occupied spaces, as is required by the Dallas Mechanical Code and ASHRAE standards. In addition to alleviating odors and maintaining occupant comfort, outdoor air serves to dilute infectious aerosols, such as Mycobacterium tuberculosis droplet nuclei that are responsible for TB transmission. Since the TB outbreak began, the shelter has taken numerous steps to improve administrative controls, particularly when it comes to identifying guests showing signs and symptoms of TB. We recommend additional improvements to the administrative and environmental controls at the shelter. From a ventilation standpoint, we suggest that all occupied spaces at the shelter be served by mechanical ventilation and all areas supplied with adequate amounts of outdoor air, as prescribed by the Dallas Mechanical Code and ASHRAE standards. In addition, we identified areas, at least one of which should be converted for respiratory separation purposes. This space could serve to separate a guest suspected of having TB or other respiratory diseases from the remainder of the guest population, until medical evaluation, transport or treatment could be obtained. We also recommend developing a written infection control plan, an HVAC operation and maintenance plan, and a written respiratory protection program. Having these plans/programs in place will help the shelter under normal operating conditions, and especially during future outbreaks of respiratory disease.
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(2014) Environmental controls at a homeless shelter associated with a tuberculosis outbreak - Texas. (Click to open report) On May 22, 2013, the National Institute for Occupational Safety and Health (NIOSH) received a request for technical assistance from the shelter manager at a large homeless shelter in Dallas, Texas, linked to an ongoing tuberculosis outbreak. The request asked NIOSH to assess the heating, ventilation, and air-conditioning (HVAC) systems and make recommendations to improve overall environmental controls at the shelter. During an on-site evaluation of the homeless shelter in June 2013, we collected... (Click to show more)On May 22, 2013, the National Institute for Occupational Safety and Health (NIOSH) received a request for technical assistance from the shelter manager at a large homeless shelter in Dallas, Texas, linked to an ongoing tuberculosis outbreak. The request asked NIOSH to assess the heating, ventilation, and air-conditioning (HVAC) systems and make recommendations to improve overall environmental controls at the shelter. During an on-site evaluation of the homeless shelter in June 2013, we collected physical and ventilation measurements in all key areas of the facility. We focused on areas where shelter guests typically congregate or spend significant amounts of time. We recorded the make and model number of all air-handling units (AHUs) providing air to the facility, and visually inspected the units. When possible, we measured the air flow rate through supply diffusers and return grilles. The AHUs in place were state-of-the-art and were controlled by a modern building automation system. The ventilation systems were well maintained and functional during our visit, and all AHUs were equipped with proper filter configurations. Despite their excellent condition and maintenance, certain aspects of the ventilation systems' operation could potentially contribute to airborne disease transmission among shelter guests. During our visit, it appeared the AHUs were not providing adequate outdoor air to the occupied spaces under certain occupancy and environmental conditions, as is required by the Dallas Mechanical Code and ASHRAE standards. In addition to alleviating odors and maintaining occupant comfort, outdoor air serves to dilute infectious aerosols, such as Mycobacterium tuberculosis droplet nuclei that are responsible for TB transmission. Since the TB outbreak began, the shelter has taken numerous steps to improve administrative controls, particularly when it comes to identifying guests showing signs and symptoms of TB. We recommend additional improvements to the administrative and environmental controls at the shelter. From a ventilation standpoint, we suggest that all occupied spaces at the shelter complex be supplied adequate amounts of outdoor air, as prescribed by the Dallas Mechanical Code and ASHRAE standards. In addition, we identified an area that should be converted for respiratory separation purposes. This space could serve to separate a guest suspected of having TB or other respiratory diseases from the remainder of the guest population, until medical evaluation, transport or treatment could be obtained. We also recommend developing a written infection control plan, an HVAC operation and maintenance plan, and a written respiratory protection program. Having these plans/programs in place will help the shelter under normal operating conditions, and especially during future outbreaks of respiratory disease.
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(2013) Environmental controls at a homeless shelter (City Rescue Mission-New Life Inn) associated with a tuberculosis outbreak - Florida. (Click to open report) In May 2012, the National Institute for Occupational Safety and Health (NIOSH) received a request for technical assistance from the Duval County Health Department as part of its response to an ongoing tuberculosis (TB) outbreak among homeless persons in Florida. The request asked NIOSH to assess heating, ventilation, and air-conditioning (HVAC) systems and make recommendations to improve overall environmental controls at four homeless facilities with epidemiologic links to past or ongoing TB dis... (Click to show more)In May 2012, the National Institute for Occupational Safety and Health (NIOSH) received a request for technical assistance from the Duval County Health Department as part of its response to an ongoing tuberculosis (TB) outbreak among homeless persons in Florida. The request asked NIOSH to assess heating, ventilation, and air-conditioning (HVAC) systems and make recommendations to improve overall environmental controls at four homeless facilities with epidemiologic links to past or ongoing TB disease transmission. During an on-site evaluation of the City Rescue Mission-New Life Inn homeless shelter in August 2012, we collected physical and ventilation measurements in all key areas of the facility. We focused on areas where shelter guests typically congregate or spend significant amounts of time. We recorded the make and model number of all air-handling units (AHUs) providing supply air to the facility, and visually inspected the units. When possible, we measured the air flow rate through supply diffusers and return grilles. The ventilation systems in place could have contributed to airborne disease transmission among shelter guests. With the exception of condensate leakage from a few AHUs, the units appeared sufficiently maintained to be fully operational. Unfortunately, none of the AHUs provided fresh outdoor air to the occupied spaces, as required by the Florida Building Code and the American Society of Heating, Refrigerating and Air-Conditioning Engineers design standards. In addition to alleviating odors and maintaining occupant comfort, outdoor air serves to dilute infectious aerosols, such as Mycobacterium tuberculosis droplet nuclei that are responsible for TB transmission. Since the TB outbreak began, City Rescue Mission-New Life Inn has taken numerous steps to improve administrative controls, particularly when it comes to identifying guests showing signs and symptoms of TB. We recommend additional improvements to the administrative and environmental controls at the shelter. From a ventilation standpoint, we suggest that all occupied spaces in the shelter are supplied adequate amounts of outdoor air. In addition, we identified areas that could be converted for use as respiratory separation areas. These spaces could serve to separate guests suspected of having TB or other respiratory diseases from the remainder of the guest population, until medical evaluation or treatment could be obtained. We also recommend developing a written infection control plan, HVAC operation and maintenance plan, and a written respiratory protection program. Having these plans/programs in place will help the shelter under normal operating conditions, and especially during future outbreaks of respiratory disease.
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(2013) Environmental controls at a homeless shelter (Trinity Rescue Mission) associated with a tuberculosis outbreak - Florida. (Click to open report) In May 2012, the National Institute for Occupational Safety and Health (NIOSH) received a request for technical assistance from the Duval County Health Department as part of its response to an ongoing tuberculosis (TB) outbreak among homeless persons in Florida. The request asked NIOSH to assess heating, ventilation, and air-conditioning (HVAC) systems and make recommendations to improve overall environmental controls at four homeless facilities with epidemiologic links to past or ongoing TB dis... (Click to show more)In May 2012, the National Institute for Occupational Safety and Health (NIOSH) received a request for technical assistance from the Duval County Health Department as part of its response to an ongoing tuberculosis (TB) outbreak among homeless persons in Florida. The request asked NIOSH to assess heating, ventilation, and air-conditioning (HVAC) systems and make recommendations to improve overall environmental controls at four homeless facilities with epidemiologic links to past or ongoing TB disease transmission. During an on-site evaluation of the Trinity Rescue Mission homeless shelter in August 2012, we collected physical and ventilation measurements in all key areas of the facility. We focused on areas where shelter guests typically congregate or spend significant amounts of time. We recorded the make and model number of all air-handling units (AHUs) providing supply air to the facility, and visually inspected the units. When possible, we measured the air flow rate through supply diffusers and return grilles. The ventilation systems in place could have contributed to airborne disease transmission among shelter guests. With the exception of some improper filter configurations and the use of inefficient filters in AHUs, the units typically used at the shelter appeared adequately maintained and were fully operational. Unfortunately, none of the AHUs provided fresh outdoor air to the occupied spaces, as required by the Florida Building Code and the American Society of Heating, Refrigerating and Air-Conditioning Engineers design standards. In addition to alleviating odors and maintaining occupant comfort, outdoor air serves to dilute infectious aerosols, such as Mycobacterium tuberculosis droplet nuclei that are responsible for TB transmission. Since the TB outbreak began, Trinity Rescue Mission reportedly has not made any significant improvements to their administrative controls, particularly when it comes to identifying guests showing signs and symptoms of TB. We recommend that Trinity start working closely with Duval County Health Department to make improvements to the administrative controls at the shelter. From an environmental control standpoint, we suggest that all occupied spaces in the shelter are supplied adequate amounts of outdoor air based upon occupancy and room use. In addition, areas within the men's and women's facilities should be converted for use as respiratory separation areas, when necessary. These spaces could serve to separate guests suspected of having TB or other respiratory diseases from the remainder of the guest population, until medical evaluation or treatment could be obtained. To provide additional protection to the 104 guests typically housed in the men's sleeping area, we recommend installing an upper-room ultraviolet germicidal irradiation system. We also recommend developing a written infection control plan, HVAC operation and maintenance plan, and a written respiratory protection program for the shelter. Having these plans/programs in place will help Trinity Rescue Mission under normal operating conditions, and especially during future outbreaks of respiratory disease.
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(2013) Environmental controls at a homeless shelter complex (City Rescue Mission--McDuff Campus) associated with a tuberculosis outbreak - Florida. (Click to open report) In May 2012, the National Institute for Occupational Safety and Health (NIOSH) received a request for technical assistance from the Duval County Health Department as part of its response to an ongoing tuberculosis (TB) outbreak among homeless persons in Florida. The request asked NIOSH to assess heating, ventilation, and air-conditioning (HVAC) systems and make recommendations to improve overall environmental controls at four homeless facilities with epidemiologic links to past or ongoing TB dis... (Click to show more)In May 2012, the National Institute for Occupational Safety and Health (NIOSH) received a request for technical assistance from the Duval County Health Department as part of its response to an ongoing tuberculosis (TB) outbreak among homeless persons in Florida. The request asked NIOSH to assess heating, ventilation, and air-conditioning (HVAC) systems and make recommendations to improve overall environmental controls at four homeless facilities with epidemiologic links to past or ongoing TB disease transmission. During an on-site evaluation of the City Rescue Mission-McDuff Campus homeless shelter complex in August 2012, we collected physical and ventilation measurements in all key areas of the facility. We focused on areas where guests typically congregate or spend significant amounts of time. We recorded the make and model number of all air-handling units (AHUs) providing supply air to the facility, and visually inspected the units. When possible, we measured the air flow rate through supply diffusers and return grilles. The ventilation systems in place could have contributed to airborne disease transmission among shelter guests. With the exception of some improper filter configurations and standing water inside one unit, the AHUs appeared adequately maintained and were fully operational. Unfortunately, none of the AHUs provided fresh outdoor air to the occupied spaces, as required by the Florida Building Code and the American Society of Heating, Refrigerating and Air-Conditioning Engineers design standards. In addition to alleviating odors and maintaining occupant comfort, outdoor air serves to dilute infectious aerosols, such as Mycobacterium tuberculosis droplet nuclei that are responsible for TB transmission. Since the TB outbreak began, City Rescue Mission-McDuff Campus has taken numerous steps to improve administrative controls, particularly when it comes to identifying guests showing signs and symptoms of TB. We recommend additional improvements to the administrative and environmental controls at the shelter. From a ventilation standpoint, we suggest that all occupied spaces at the shelter complex are supplied adequate amounts of outdoor air. In addition, we identified areas that could be converted for use as respiratory separation areas. These spaces could serve to separate guests suspected of having TB or other respiratory diseases from the remainder of the guest population, until medical evaluation, transport or treatment could be obtained. We also recommend developing a written infection control plan, HVAC operation and maintenance plan, and a written respiratory protection program. Having these plans/programs in place will help the shelter under normal operating conditions, and especially during any future outbreaks of respiratory disease.
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(2013) Environmental controls at a social assistance facility (Community Rehabilitation Center) associated with a tuberculosis outbreak - Florida. (Click to open report) In May 2012, the National Institute for Occupational Safety and Health (NIOSH) received a request for technical assistance from the Duval County Health Department as part of its response to an ongoing tuberculosis (TB) outbreak among homeless persons in Florida. The request asked NIOSH to assess heating, ventilation, and air-conditioning (HVAC) systems and make recommendations to improve overall environmental controls at four homeless facilities with epidemiologic links to past or ongoing TB dis... (Click to show more)In May 2012, the National Institute for Occupational Safety and Health (NIOSH) received a request for technical assistance from the Duval County Health Department as part of its response to an ongoing tuberculosis (TB) outbreak among homeless persons in Florida. The request asked NIOSH to assess heating, ventilation, and air-conditioning (HVAC) systems and make recommendations to improve overall environmental controls at four homeless facilities with epidemiologic links to past or ongoing TB disease transmission. During an on-site evaluation of the Community Rehabilitation Center social assistance facility in August 2012, we collected physical and ventilation measurements in all key areas of the facility. We focused on areas where guests typically congregate or spend significant amounts of time. We recorded the make and model number of air-handling units (AHUs) providing supply air to the facility, and visually inspected the units. When possible, we measured the air flow rate through supply diffusers and return grilles. The ventilation systems in place could have contributed to airborne disease transmission among facility guests. With the exception of some window units in the older portion of the main building, the AHUs appeared adequately maintained and were fully operational. Unfortunately, none of the AHUs provided fresh outdoor air to the occupied spaces, as required by the Florida Building Code and American Society of Heating, Refrigerating and Air-Conditioning Engineers design standards. In addition to alleviating odors and maintaining occupant comfort, outdoor air serves to dilute infectious aerosols, such as Mycobacterium tuberculosis droplet nuclei that are responsible for TB transmission. Since the TB outbreak began, Community Rehabilitation Center has taken numerous steps to improve administrative controls, particularly when it comes to identifying guests showing signs and symptoms of TB. We recommend additional improvements to the administrative and environmental controls at the center. From a ventilation standpoint, we suggest that all occupied spaces in the facility are supplied adequate amounts of outdoor air. We also recommend developing a written infection control plan, HVAC operation and maintenance plan, and a written respiratory protection program. Having these plans/programs in place will help the center under normal operating conditions, and especially during future outbreaks of respiratory disease.
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(2013) Exposure to tuberculosis among employees at a long-term care facility (revised). (Click to open report) Investigators with the HHE Program evaluated employee exposure to Mycobacterium tuberculosis at a long-term care facility. Managers asked for assistance in identifying disease sources and assessing the ventilation system. HHE Program investigators interviewed 216 employees, reviewed employee health records, and reviewed medical records of 53 residents in one area of the facility. The records showed that 12 residents and 16 employees had latent tuberculosis infection. One resident had active pulm... (Click to show more)Investigators with the HHE Program evaluated employee exposure to Mycobacterium tuberculosis at a long-term care facility. Managers asked for assistance in identifying disease sources and assessing the ventilation system. HHE Program investigators interviewed 216 employees, reviewed employee health records, and reviewed medical records of 53 residents in one area of the facility. The records showed that 12 residents and 16 employees had latent tuberculosis infection. One resident had active pulmonary tuberculosis disease, which was the likely source of latent tuberculosis infection among 8 residents and 16 employees. Investigators did not observe a clear pattern between the ventilation system and tuberculosis transmission. HHE Program investigators recommended that residents be monitored clinically for signs and symptoms of active tuberculosis disease at least once a month. Until a risk assessment shows they can be done less often, tuberculosis screening for residents, employees, and direct care volunteers in the area of concern should be continued at least every 6 months. Similarly, employees with a prior negative skin test should get a tuberculin skin test at least every 6 months and employees with a positive tuberculin skin test in the past should have a medical evaluation for tuberculosis at least every 6 months, or until the risk assessment suggests otherwise. The ventilation system should be upgraded to provide improved filtration in resident areas and air temperatures kept in accordance with current guidelines for nursing homes.
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