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Module 8: Tuberculosis Surveillance and Case Management in Hospitals and Institutions
Background

In this module, you will learn about the role of public health workers (e.g., public health advisors, DOT outreach workers) in conducting tuberculosis (TB) surveillance and case management in hospitals or institutional settings. This module will familiarize you with a systematic process for managing TB patients in these settings. The process begins with the identification of suspected or confirmed TB cases by routine case reporting and by active case finding through periodic visits to laboratories and pharmacies. Active case finding and routine case reporting are followed by the collection of patient information from medical records and other sources. This information prepares the public health worker for an initial interview that is used to establish the basis for a good relationship with the patient, to begin a contact investigation, and to assess the patient's individual needs. Finally, you will learn about planning for a patient's follow-up care while in the facility and after discharge.

Keep in mind that the duties of public health workers vary from situation to situation. Often, a public health worker is assigned to a hospital or institution to assist in surveillance activities and case management duties. The resources of many TB programs may not be adequate to support the broad range of activities recommended in this module; however, it may be appropriate in some areas to target specific hospitals or institutions or specific public health functions, according to local needs. This module is therefore intended to present an overview of public health duties related to TB control in hospital and institutional settings; it does not advocate specific duties and functions for individuals.

Objectives

After working through this module, you will be able to:

  1. Explain the primary goals of TB prevention and control.
  2. Describe the process of conducting TB surveillance and case management in hospitals and institutions.
  3. Explain the importance of good communication with patients and with hospital or institutional staff.
  4. Describe specific considerations for conducting TB surveillance and case management in correctional facilities.
  5. List the hospital or institutional staff with whom the public health workers may collaborate.
  6. Describe how public health workers support hospital or institutional staff in the care of patients with TB.
  7. Discuss the case definition and criteria for the classification of suspected and confirmed TB cases.
  8. Explain the two basic methods for identifying suspected or confirmed TB cases and how they are put into practice.
  9. Explain how to use information found in laboratories and pharmacies for surveillance.
  10. Explain how to locate the patient and identify available information sources.
  11. Discuss the importance of the initial patient interview.
  12. Explain how to assess the patient's potential for adherence.
  13. Describe the seven main sections of the patient's medical record.
  14. Describe the responsibility of the TB program to every suspected or confirmed TB case.
  15. Describe the purpose of planning for discharge from the facility.
  16. Describe how information is gathered about patients who are discharged, leave the facility, or die.
  17. Describe procedures that should be used in the interjurisdictional referral of patient information.

New Terms

Lists of new terms were introduced in each of the five core Self-Study Modules on Tuberculosis (Modules 1-5). Please refer to the core modules or their Glossary if you encounter unfamiliar terms related to TB that are not defined in this New Terms section.

Look for the following new terms in this module.

action plan - a plan to determine what information is missing or pending, where and when to collect this information, and who will need the information

active case finding - identifying unreported cases of TB disease by actively searching for them through, for example, laboratory and pharmacy audits

adherence plan - a written plan that is based on the patient's understanding and acceptance of the TB diagnosis, that addresses barriers to adherence, and that details the method chosen to deliver treatment and monitor adherence for that specific patient

admission note - patient information recorded at the time of admission to a hospital, usually including the admission diagnosis and initial plan for diagnostic work-up; usually included in the progress notes

AFB logbook - a logbook kept in the mycobacteriology laboratory that contains the results of acid-fast bacilli (AFB) smear examinations; it may be called a smear mycobacteriology log

case management - a system in which a specific health department employee is assigned primary responsibility for the patient, systematic regular review of patient progress is conducted, and plans are made to address any barriers to adherence

discharge planning - the preparation of a detailed plan for comprehensive care of a hospitalized or institutionalized patient after that patient's discharge

discharge summary - a document written by the patient's physician upon discharge; contains a brief summary of all important information from the entire hospitalization or stay in the institution, including the discharge diagnosis and often a plan for follow-up care

emergency room/department assessment form - patient information recorded when a patient is brought to an emergency room; may be used instead of an admission note and is usually included in the progress notes

first-line TB drugs - the initial drugs used for treating TB disease. Include isoniazid (INH), rifampin (RIF), pyrazinamide (PZA), and either ethambutol (EMB) or streptomycin (SM)

history and physical exam form - a standardized form sometimes used to record patient information at the time of the patient’s first evaluation; may be used instead of an admission note and is usually included in the progress notes; it is also referred to as the H&P

hospital epidemiologist - a specially trained person who studies the causes of outbreaks and other health problems in a health care setting

identification data - includes the patient’s name, address, social security number, date of birth, and other demographic information (may be a separate registration form)

infection control practitioner - a trained health care professional (often a nurse) who is responsible for controlling and preventing the spread of infectious diseases in a hospital or other health care setting

institutions - residential facilities where groups of people live, such as nursing homes, correctional facilities, or homeless shelters, as well as out-patient facilities, such as drug treatment centers or health department clinics

laboratory results - records presenting the results of every laboratory test that has been done on the patient, such as AFB smear examinations, cultures, and drug susceptibility tests performed in a laboratory

latent TB infection (LTBI) - also referred to as TB infection. Persons with latent TB infection carry the organism that causes TB but do not have TB disease, are asymptomatic, and noninfectious. Such persons usually have a positive reaction to the tuberculin skin test

medical records department - a department in a hospital or other health care facility that houses the records of patients who have been admitted to the hospital and subsequently have been discharged, transferred to ambulatory care services, left against medical advice, or died

medication record - an information sheet on which the nurses record the date, time, and amount of prescribed medications given to the patient during hospitalization or care in a facility; may not be included in patient’s medical record (for example, may be kept in a separate medication logbook)

nurses’ notes - a record in which the nurses who directly care for the patient continuously record information, including the patient’s symptoms, medications given, and scheduled procedures or activities and may be included in the progress notes section

out-patient clinic - a clinic that cares for non-hospitalized patients with a particular type of problem (for example, chest, infectious disease, AIDS, pediatric)

pathology laboratory - a laboratory that performs tests and examinations on tissue and biopsy specimens

physician’s orders - a record in which the physician(s) prescribes medications, orders laboratory tests or procedures (for example, bronchoscopy or gastric aspiration), and delivers other patient-care instructions to staff. Medication orders specify date, name of medication, dosage, and duration of treatment (in days or in number of doses)

progress notes - a record in which all physicians and other specialists continuously record patient information during a patient’s hospital stay and may include nurses’ notes and notes from other ancillary staff

public health worker - an employee of the health department (often a public health advisor, DOT outreach worker, or a nurse) whose duties may include either surveillance, case management, or some combination of these activities

radiology reports - reports summarizing all radiology procedures performed on the patient (for example, chest radiographs or CT scans); part of the medical record

routine case reporting - the required reporting of suspected or confirmed TB cases to a public health authority

second-line TB drugs - drugs used to treat TB that is resistant to first-line TB drugs (for example, capreomycin, kanamycin, ethionamide, cycloserine, ciprofloxacin, amikacin)

SOAP notes - Progress notes can also be referred to as SOAP notes: subjective progress, objective progress, assessment, and plans

surveillance - the ongoing systematic collection, analysis, and interpretation of health data essential to the planning, implementation, and evaluation of public health practice, closely integrated with the timely dissemination of these data to those who need to know in public health programs

treatment plan - a written plan detailing the medical regimen as ordered by the physician, including periodic monitoring for adverse reactions and other follow-up care

 
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