How to pin down Tuberculosis in the workplace

2New cases of Tuberculosis or TB are still being reported in Singapore. Although the spread of TB is within control, the community needs to be aware of how TB is spread, what to do and where to seek medical treatment if they are infected.

TB is caused by bacteria that usually attack the lungs. It can also affect other parts of the body such as the kidneys, spine and brain. If not treated properly, TB can be fatal.

Fortunately, TB can be cured as long as it is promptly diagnosed and treated. You are in a great position to help your workforce should any of them develop the disease.

This book can help you understand how TB can be best managed in the workplace. Read on to find out exactly how to protect your workforce and manage TB to minimise disruptions to the workflow and productivity of your company.

3What is TB and

how

does it spread?

Protecting your staff

from TB transmission

Managing TB in the workplace

Treating and curing TB

4TB is a disease caused by bacteria called Mycobacterium tuberculosis. It usually affects the lungs (pulmonary tuberculosis), but can also infect other parts of the body (extrapulmonary tuberculosis), such as the brain, lymph nodes, kidneys, bones and joints.

The general symptoms of TB include feelings of sickness or weakness, weight loss, fever, and night sweats. The symptoms of TB in the lungs also include an ongoing cough, chest pain, and coughing up blood.

Symptoms of TB in other parts of the body depend on the area affected.

What is TB and how does it spread?

5TB is an airborne infection. When someone with TB coughs or sneezes, TB bacteria are released into the air and can stay there for several hours. People nearby may breathe in these bacteria and become infected.

In this way, an untreated person will pass TB on to 10 15 people each year. On average, one in 10 of those people will develop active, contagious TB, while the rest will not have any symptoms or be able to pass the disease onto others.

TB transmission

Risk of getting TB

Active TB develops in about 10% of infected people even if they have a healthy immune system. However, if the persons immune system is weakened, e.g. by other health conditions, the chance of getting sick will be higher. Hence, the risk of developing active TB is greater among:

Children, who have naturally weaker immune systems

People in close contact with untreated infectious TB cases

People with underlying medical conditions such as HIV infection and diabetes

6Transmission depends on How many bacteria droplets are in the air How strong the type of bacteria is The size of the room The ventilation of the room

People with active TB are most likely to spread the bacteria to people they spend time with every day, such as household and family members, friends, co-workers or schoolmates.

Factors that affect transmission

7In most parts of the world, especially in developing countries, TB is a major cause of death and disability. Untreated TB can cause severe complications such as bleeding in the lungs and respiratory failure, and can be fatal.

However, with the right and complete treatment TB can be cured.

It is important to recognise the symptoms of TB, as that is the first step towards diagnosis and cure. The next chapter outlines the early signs of disease, and the appropriate measures to take.

Understandingthe risks

8Protecting your staff from TB transmission

Symptoms of TB

The single most effective way to prevent TB transmission is to make sure that the person with active TB is diagnosed early and treated properly.

By knowing the signs and symptoms, you can ensure that your workers get the treatment and care they need.

Cough that lasts for more than 3 weeks Weight loss Fever Night sweats Loss of appetite Coughing up blood

9The most common symptom of pulmonary TB (or TB that affects the lungs) is an ongoing cough for 3 weeks or more.

This is the key thing to remember anyone who has a persistent cough may have TB in his or her lungs.

If someone on your workforce has had a cough for 3 or more weeks, they should be referred to a medical practitioner for assessment.

Someone who is diagnosed with TB will need to take medical leave for the first 2 weeks of treatment, so arrangements will need to be made to cover his or her duties.

After completion of the first 2 weeks of treatment, most people are able to re-join the workforce, posing no risk of transmission to others. However, they must continue treatment for at least 6 months in order to be cured of the disease.

The best way to ensure that a TB patient is properly treated and cured is for him or her to undergo supervised treatment (Directly Observed Therapy or DOT, see page 13).

The most common symptom of TB

Defending your workforce

10

A doctor who diagnoses a person with TB is required by law to notify the Ministry of Health (MOH) National TB registry. The TB Control Unit (TBCU) then follows a three-step procedure:

1. TBCU identifies people who may have been put at risk anyone who has had close and prolonged contact with the person with active TB.

2. These close contacts are given a skin test* to find out whether they have been infected. Results are available 48 72 hrs after testing.

3. Preventive treatment may be offered to those with a positive skin test.

People with a positive skin test but no signs of active TB have dormant infection.

Contact tracing is carried out by the TBCU free of charge for identified close contacts of infectious TB patients under the National TB Control Programme.

* Called a Mantoux test a safe TB extract is injected under the skin and the skin reaction is measured.

If TB is diagnosed

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If someone suspects that he or she has been exposed to TB, there are a few important things to remember:

You would have to breathe in TB bacteria from someone with active disease in order to become infected yourself The inhaled bacteria would have to multiply in your body to cause active TB

Exposure to TB

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S M T

1

6 7 8

13 14 15

20 21 22

27 28 29

Once TB has been diagnosed it needs to be treated so the patient can recover and the spread of TB can be prevented or minimised. Most cases can be treated on an outpatient basis. TB drugs are provided free to patients treated under DOT (Directly-Observed Treatment) by the TB Control Unit. It is important that patients take the right combination of drugs for the right length of time (6 9 months) in order to make a full recovery. If the TB is not drug-resistant, and the full course of treatment is taken, more than 95% of all patients can be cured.*

*Source: www.moh.gov.sg

Treating and curing TB

It is vital that anyone with TB completes his or her full course of medication. People often start to feel better after the first few weeks of treatment, and may stop or partially skip their treatment for the next few months.

Incomplete treatment is worse than no treatment at all as the TB bacteria will grow resistant to the drugs that are first used. When this happens, it becomes necessary to use different drugs for a longer duration, and it becomes more difficult to achieve a cure.

13A full course of medication is key

13

W T F S

2 3 4 5

9 10 11 12

16 17 18 19

23 24 25 26

30 31

16

DOT, or Directly Observed Treatment, involves taking TB treatment under the supervision of a nurse or other healthcare professional. This ensures that the patient adheres to the treatment regimen, which increases his or her chance of being cured.

Directly Observed Treatment

Don't miss any treatment doses.

14

The previous pages provide the information you need to recognise the early signs of TB and support any employee who becomes infected with the bacteria. In addition, the following tips provide a guide to offering the best response to TB within the workplace.

Managing TB in the workplace

1. Recognise that TB is a workplace issue. TB affects businesses as it increases labour costs and

reduces productivity you could help your company and your employee by providing TB education.

2. Create awareness. This booklet and accompanying materials can help you

educate your workforce about TB. Employees should understand that anyone can be infected, but that treatment is simple and effective. They should also know where to seek more information, medical consultation and treatment.

3. Ensure non-discrimination. No one should be discriminated against or penalised because

of his or her real or possible TB status. Fear of stigmatisation makes people less likely to seek diagnosis, and therefore makes it harder to stop the spread of this disease.

Employers should support TB patients by encouraging them to adhere to and complete the treatment course, by allowing them time to attend DOT where necessary.

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4. Respect confidentiality. Other members of your workforce do not need to know

about a co-workers TB status. Ensuring confidentially means employees will place more trust in your managements professionalism and your TB workplace health-promotion programme, which will help it be more effective.

5. Facilitate maintenance of DOT. Employees need to continue their DOT until they are

completely cured. Supervisors at work should exercise empathy and concern for their employees and facilitate their continuation of DOT at their nearest polyclinic.

For example, allow flexible working hours or time off to

receive DOT. Remember that in making these arrangements, confidentiality on employees TB status should be maintained.

6. Develop a sustainable network of TB programme partners. There are various healthcare organisations like SATA

CommHealth (Tel: 6244 6688; www.sata.com.sg) that can provide long-term resources, support and information for workplace TB programmes.

Copyright HPB B E 614-10April 2010

For more information on TB,

please visit

www.hpb.gov.sg/infectiousdiseases

Health Promotion Board 3 Second Hospital Avenue, Singapore 168937

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