Student ______________________________________________________ Instructor ____________________________________________________

PERFORMANCE CHECKLIST PROCEDURAL GUIDELINE 7-1

Date _________________________ Date _________________________

SPECIAL TUBERCULOSIS PRECAUTIONS

S 1. Assessed potential for infection. 2. Performed hand hygiene. 3. Applied mask and checked fit. 4. Explained purpose of TB isolation to patient, family, and relevant others. 5. Instructed patient to cover mouth with a tissue when coughing and to wear a disposable surgical mask when leaving room. 6. Provided scheduled care. 7. Closed the door upon leaving the room. 8. Removed mask: a. If disposable, discarded in the proper receptacle. b. If reusable, placed in labeled bag for storage and avoided crushing mask. 9. Assessed patients laboratory data for repeated AFB smears that may be negative. 10. Asked patient and family to identify method of transmission of TB. 11. Assessed any suspected respiratory symptoms in neighboring patients.

NP

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