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Module 8: Tuberculosis Surveillance and Case Management in Hospitals
Reading Material

TB in Correctional Facilities

Overview

This module addresses TB surveillance and case management in hospitals and institutions in general. However, because of the unique challenges posed by controlling TB in correctional facilities, a brief overview of the health department's and correctional facilities' role in TB surveillance and case management follows.

TB poses a particular challenge today in correctional environments (Figure 8.2 and Figure 8.3), as inmate populations increase and overcrowding makes outbreaks of TB a serious threat. Control of TB is an essential element in correctional health care.

All correctional facilities--even facilities in which few cases of TB are expected--should have a written TB infection control plan and should designate a person or group of persons who will be responsible for the TB infection control program in the facility.

State and local health departments should form close working relationships with correctional facility officials. Health departments can assist correctional facilities in formulating, implementing, and evaluating essential TB control activities.

Figure 8.2 Correctional facility intake.

This is a picture of a correctional facility intake area

Figure 8.3 Correctional facility.

This is a picture of a correctional facility ward.

Role of the Health Department

Health departments should assist correctional facilities in developing and updating policies, procedures, and record systems for TB control. The health department should also provide access to expert TB medical consultation and ensure that correctional facilities have access to adequate laboratory services. A specific health department contact person should be designated to provide epidemiologic and management assistance to correctional facilities. This responsibility may initially require considerable onsite consultation at the correctional facility. Small jails may need more direct support from the health department. For instance, it may be possible for health department staff to perform screening activities or administer directly observed therapy (DOT).

Health department staff should help develop programs to train correctional facility staff to

  • Create TB control policies and procedures
  • Perform, read, and record tuberculin skin tests (Figure 8.4)
  • Identify signs and symptoms of TB disease
  • Initiate and observe therapy
  • Monitor medication side effects
  • Collect diagnostic specimens
  • Educate inmates
  • Maintain record systems
  • Provide tracking and patient record system
  • Ensure released inmates complete therapy

Figure 8.4 Correctional facility nurse administering a tuberculin skin test at intake.

This is a picture of a correctional facility nurse administering a tuberculin skin test at intake.

Health departments should also provide consultation for contact investigations for each case within correctional facilities and ensure appropriate examinations for community contacts of the persons found to have TB in these facilities. In addition, health departments should cooperate with correctional staff in identifying TB among persons who enter the facility and arranging continued treatment for inmates released while receiving TB treatment or treatment for LTBI.

Health departments have a responsibility to maintain TB registries with updated medical information on all current TB patients in their jurisdictions, including persons in correctional facilities. Cross-matching information from the TB registry with the names of inmates admitted into correctional facilities can help identify persons with TB disease who fail to report their TB history or locate patients who have been lost. TB case records should be assessed quarterly, and necessary revisions in policies or procedures should be recommended. In addition, health departments should regularly collect information on TB cases reported in correctional facility inmates and staff, and should periodically assess the impact of TB infection and disease in correctional facilities on the community as a whole.

Because some inmates may have both TB and HIV infection, health department officials should assist correctional facilities in developing and implementing HIV prevention programs. Such programs should include strategies to identify persons practicing high-risk behaviors, to reduce high-risk behaviors among all inmates, and to provide counseling and testing services to HIV-infected persons.

Role of the Correctional Facility

The correctional facility should be responsible for in-facility TB screening, containment, and assessment unless otherwise mandated by legal statute. In all correctional facilities, officials should work closely with the state and local health departments in the jurisdiction. Correctional facilities, including local jails, are advised to have formal written working agreements with the health department in their area.

These written agreements should delineate responsibilities and specify procedures for the following activities:

  • Evaluation and treatment of inmates
  • Surveillance to ensure that cases of TB are promptly reported, counted, and recorded
  • Follow-up of symptomatic inmates
  • Follow-up of inmates who have abnormal chest radiologies
  • Contact investigation within the facility for reported TB cases and follow-up with the health department for contact investigation of potentially exposed patients outside the facility
  • Follow-up of inmates released before completing treatment for TB disease
  • Follow-up of inmates released before completing treatment for LTBI

Correctional facilities should also collaborate with health department staff to provide education and counseling about TB to inmates and staff.

It may be necessary for correctional facility staff to request health departments and receiving facilities to formally notify them of the arrival of referred inmates on DOT who are released or transferred into the jurisdiction. This is a very important component of a good TB control program, since persons who are lost to follow-up are at high risk of never completing therapy, developing drug-resistant TB disease, and spreading TB to others. Inmates on DOT for LTBI who are released or transferred to other correctional facilities should also be referred for follow-up treatment.

Summary of the Role of Health Departments in TB Surveillance and Case Management in Correctional Facilities

Health department staff should

  • Designate a specific person to work with correctional facilities
  • Ensure that cases of TB are promptly reported, counted, and recorded
  • Provide information from the TB registry in the health department so that information from the TB registry can be cross-matched with names of inmates admitted into correctional facilities to identify persons with TB disease who fail to report their TB history
  • Assist correctional facilities in developing, implementing, and updating
    • TB control policies and procedures
    • Training and educational programs
    • Tracking and patient record systems
    • HIV prevention programs
  • Ensure that released inmates complete therapy
  • Assist with contact investigations in and outside correctional facilities
  • Analyze TB morbidity in correctional facilities
  • Provide or refer to expert clinical consultation
  • Ensure access to adequate laboratory services
Study Questions 8.6-8.7

8.6. What are some of the roles of the health department staff in the surveillance and case management of TB patients in correctional facilities?

8.7. What can correctional facilities do to help ensure completion of therapy for inmates released or referred while being treated for infection or disease?

Answers 


 
Case Study 8.1
As the new public health worker at the state prison (or in any other facility to which you are assigned), you are asked to attend a staff meeting where you have the opportunity to present to the administration a description of your job, your role at the facility, and the process you use to conduct your work. Because you suspect that the facility director has some misunderstandings about TB control, you are quite pleased to have this opportunity. You begin to prepare diligently for the meeting.
  • What will you tell the director about the primary goals of TB prevention and control?
  • How will you describe your role at the facility and the process you use to conduct your work?

Answers 


 
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