Karen,

If this is in fact the actual policy at your facility someone has seriously missed the boat on this one. Exposures in the pathology frozen section room or autopsy room are not uncommon and I simply can't imagine refusing surveillance to this population of employees. I hope that the individual who turned your tech away is simply misinformed and will get re-training. This is a perfect example of others in the hospital community not knowing and understanding what we do in pathology.

I suggest that you go higher in the chain, contacting the epidimiologist at your facility to elicit his/her support for getting the tuberculin test done. The CDC declared a long time ago that the act of sectioning fresh frozen tissues with a cryostat microtome,, that is, the very passing of the blade through the block,  creates aerosols. And as you aptly pointed out, someone determined that you qualify for the N95 mask and this implies that there was a perceived risk of exposure in your environment.

good luck and let us know how this turns out.
Vinnie


Vinnie Della Speranza
Manager for Anatomic Pathology Services
Medical University of South Carolina
165 Ashley Avenue  Suite 309
Charleston, SC 29425
Ph: 843-792-6353
fax: 843-792-8974

>>> "Bauer, Karen"  06/02/04 12:30PM >>>
Hi to all,

I'm curious to find out what different procedures are out there dealing with
possible TB exposures.  

We had a lung case that we did a frozen section on, not realizing that it
was a possible TB case.  After special stains and cultures came back
positive, one of our Pathologists told the tech who did the frozen to go get
a baseline TB skin test done and then follow up 12 weeks later.  When she
went to receive the test, they turned her away, stating that she does not
qualify as an exposure.  An exposure is defined as "being within the same
confined space for at least one hour with a clinically symptomatic patient
without respiratory protection".  So, I'm a little confused.  If we are
doing a frozen on TB infected lung tissue, with no hood or ventilation
drawing the air away from us, spraying Cyto-Cool all over it (probably
causing the bacteria to scatter all over), then why do we get fitted for
special masks to protect ourselves?  We do wear our masks if we know a
patient is infected with TB, but do not routinely wear them for every lung
case.  And, if we are only exposed by being with the patient, then we should
never have to wear our masks. 

How are others dealing with this?

Thanks in advance!!

Karen Bauer HT(ASCP)
Histology Supervisor


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