Clinical Pathway for Managing Tuberculosis Suspects/Cases in Corrections

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Clinical Pathway: Managing Tuberculosis Suspects/Cases in Corrections

TB case management in correctional facilities can be a challenge to administrators and infection control staff who have not worked with tuberculosis for some time. There are many components that must be accomplished, including identification and isolation, reporting, diagnosis and treatment, and planning for the eventual release of the inmate. Through the use of this form, the medical staff can identify all the steps needed when caring for a case of tuberculosis, infectious or not.

Best Practice: Case management is best done in conjunction with the local health department whenever possible.

This form can aid in the day to day tasks required when caring for an inmate with tuberculosis (TB). Through the use of this form, the nurse completing these tasks can be assured that all aspects of TB are complete and up to date, and any areas where further assistance is required can be identified early in treatment.

Terminology and Definitions

Airborne Infection Isolation (AII) Room – Formerly, negative pressure isolation room, an AII Room is a single-occupancy patient/inmate-care room used to isolate persons with a suspected or confirmed airborne infectious disease. Environmental factors are controlled in AIIRs to minimize the transmission of infectious agents that are usually transmitted from person to person by droplet nuclei associated with coughing or aerosolization of contaminated fluids. AIIRs should provide negative pressure in the room (so that air flows under the door gap into the room); and an air flow rate of 6-12 Air Changes per Hour (ACH) (6 ACH for existing structures, 12 ACH for new construction or renovation); and direct exhaust of air from the room to the outside of the building or recirculation of air through a HEPA filter before returning to circulation (MMWR 2005; 54 [RR-17])

Break in Exposure – date the infected individual was isolated/removed from the contacts.

Conversion – A tuberculin skin test increase of 10mm or more within a 2-year period, regardless of age (i.e., 5/10/05 – TST = 4mm, tested again 3/17/07 – TST = 16mm.)

Test Conversion Rate – calculation is identified by dividing the number of conversions among workers by the number of workers who were tested and had prior negative results during a certain period.

Contacts – contacts are categorized and assessed according to priority, and include high-priority and medium priority. A contact is a person who has shared the same air space with a person who has TB disease for a sufficient amount of time to allow possible transmission of M. tuberculosis.

High-priority - those persons most likely to become infected (were in close proximity of the infectious case and for prolonged periods of time) and most likely to develop active TB disease once infected (HIV+, other immune compromised, drug users, silicosis, etc.).

Medium-priority – those persons who spent time with or was physically close to the inmate and, once infected, may develop active TB disease (low body weight, diabetes, organ transplant, cancers, renal disease, etc.

Low-priority – those persons with short duration of exposure (includes officers and staff who do not have prolonged exposure).

Exposure – the length of time spent with a person with active infectious TB disease during his/her infectious period.

Index Case – the first inmate that comes to your attention as a TB case

Infectious Period – the period during which a person with TB disease might have transmitted M. tuberculosis organisms to others. For inmates with positive AFB sputum smear results, the infectious period begins 3 months before the collection date of the first positive smear result or the date of collection for the first consistently negative smear results. For inmates with negative AFB sputum smear results, the infectious period extends from 1 month before the symptom onset date and ends when the inmate is placed into airborne infection isolation (AII), whichever is earlier.

Latent TB Infection – a person infected with the bacteria Mycobacterium tuberculosis. The person with LTBI shows no signs or symptoms of active TB, and has a negative chest x-ray and negative symptom screen.

Suspect – a person in whom the diagnosis of TB disease is being considered, regardless of whether anti-TB therapy has been started.

Best Practice: Begin and complete the contact investigation in conjunction with the local health department whenever possible.

Clinical Pathway: Managing Tuberculosis Suspects/Cases in Corrections

Name of person completing this form: Title:

Name of Health Department Staff Assist: ______Title:

Instructions: Initial and Date after each task. Observe Respiratory Precautions when speaking with infectious tuberculosis (TB) suspects/cases. Assure proper isolation and treatment of suspect/case.

Obtain sputum containers (3-6) from the health department (HD) or laboratory. Collect sputum specimens on 3 separate days or at least 8 hours apart (with one first morning specimen) If unable to expectorate, may need sputum induction either on-site at facility, HD or local hospital). Remember: Always wear a N95 mask when working with a TB suspect, and anytime a TB suspect is out of isolation, they should wear a surgical mask until no longer infectious. They do not have to wear a mask while alone in a negative AII room.

Note: At any point during incarceration the inmate is released or transferred to another facility, complete information must be sent along with the inmate.