Effective TB Interviewing for Contact Investigation: Facilitator Led Training Guide 2006
10. Course Activities
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Activity 3: Prioritization Exercise |
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Objectives
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| Time Allotted | 35 minutes total
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| Materials Needed | Easel and marker; copies of “Prioritization Exercise” on page 38 (one for each participant) | |
| Procedure |
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Figure 6. Priority Grid
| Patient | Group 1 | Group 2 | Group 3 | Your answers |
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| A | ||||
| B | ||||
| C | ||||
| D | ||||
| E | ||||
| F | ||||
| G | ||||
| H |
| Procedure (continued) | 1. After 15 minutes, ask one person from each group to
verbally call out, by numbers 1-8, the order in which they ranked each patient, starting with patient A and ending with
patient H. Tell them that their answers cannot be changed after seeing any other group’s answers.
2. Discuss any major deviations between each group. For example, if one group ranked a patient number 1, but another ranked the patient number 4, ask each group why one considered the patient to be a high priority while another felt the patient was medium priority. 3. Use the ranking to promote a discussion on reasons for prioritizing interviews. 4. Write down your answers and explain that the exact numbers do not have to be the same, but an approximate priority should be consistent. For example, patients 1-3 should be about the same in a varying order, 4-6 can vary, and 7 and 8 can be another grouping. The first grouping is the highest priority, the second is medium, and the third is the lowest. However, all of these patient interviews need to eventually be initiated within the state’s designated timeframe for interviews.
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| Tips | Since the purpose of this exercise is to prioritize interviews, participants need to understand the principles of infectiousness and apply them to the interviewing process. Therefore, page 39 has suggested answers and page 40 gives the rationale for why the cases are prioritized as indicated. Note that the answers may vary slightly. However, there should be no major discrepancies such as low-priority and high-priority cases being interchanged. |
Activity 3: Prioritization Exercise
You are the only staff member available to visit patients in the field. In addition to your regularly scheduled field assignments, your supervisor places eight new assignments on your desk for TB interviews for contact and source case investigations. Your supervisor’s advice: “Prioritize these new patients for interviewing.” Please prioritize the following assignments for interviews with ‘1’ being the highest priority and ‘8’ being the lowest priority. Note that all of the following patients must be interviewed.
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A. 25 y/o male___ TST 27 mm CXR: abnormal/noncavitary disease Sputum smear: positive (4+) Culture: ID pending Cough x3 months Currently hospitalized On TB treatment |
E. 36 y/o female____
TST 12 mm Initial CXR: infiltrates/noncavitary disease Repeat CXR improving Sputum smear/culture: negative Verified by skin test result &
improving CXR Asymptomatic |
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B. 3 y/o child___ TST 17 mm CXR: negative Private patient |
F. 29 y/o female____ Lymph node smear: negative Drainage aerosolized while dressing changed at home by family member (without mask), prior to culture ID & treatment Culture: M. tuberculosis
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C. 17 y/o male___ TST 22 mm CXR: abnormal/cavitary disease Sputum smear: negative Culture: identification pending Cough, night sweats, weight loss x2 weeks Currently hospitalized |
G. 51 y/o female___ HIV positive TST 0 mm CXR: abnormal/noncavitary disease Sputum smear: negative Culture: AFB positive; final ID pending Productive cough, night sweats, weight loss x 3 weeks Recent history of atypical mycobacterial disease |
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D. 21 y/o female___ TST 0 mm CXR: abnormal/noncavitary disease BAL smear: negative Culture: M. tuberculosis On TB treatment |
H. 62 y/o female___ TST 12 mm Larynx smear: negative Biopsy results pending CXR: infiltrates/noncavitary disease Hoarseness Currently hospitalized On TB treatment |
Key: y/o=years old; CXR=chest X-ray; ID=identification; TST=tuberculin skin test; BAL=bronchoalveolar lavage; AFB=acid fast bacilli
Activity 3: Prioritization Exercise Answer Sheet
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A. 25 y/o male_1__ TST 27 mm CXR: abnormal/noncavitary disease Sputum smear: positive (4+) Culture: ID pending Cough x3 months Currently hospitalized On TB treatment |
E. 36 y/o female__7__ TST 12 mm Initial CXR: infiltrates/noncavitary disease Repeat CXR improving Sputum smear/culture: negative Verified by skin test result & improving CXR Asymptomatic |
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B. 3 y/o child__5_ TST 17 mm CXR: negative Private patient |
F. 29 y/o female__4__ Lymph node smear: negative Drainage aerosolized while dressing changed at home by family member (without mask), prior to culture ID & treatment Culture M. tuberculosis |
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C. 17 y/o male__3_ TST 22 mm CXR: abnormal/cavitary disease Sputum smear: negative Culture: identification pending Cough, night sweats, weight loss x2 weeks Currently hospitalized
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G. 51 y/o female__8_ HIV positive TST 0 mm CXR: abnormal/noncavitary disease Sputum smear: negative Culture: AFB positive; final ID pending Productive cough, night sweats, weight loss x 3 weeks Recent history of atypical mycobacterial disease |
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D. 21 y/o female__6_ TST 0 mm CXR: abnormal/noncavitary disease BAL smear: negative Culture: recently identified as M. tuberculosis On TB treatment |
H. 62 y/o female__2_ TST 12 mm Larynx smear: negative Biopsy results pending CXR: infiltrates/noncavitary disease Hoarseness Currently hospitalized On TB treatment |
Activity 3: Prioritization Exercise
The rationale for the ratings is as follows (see answer sheet):
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Patient A: Highly infectious due to 4+ smear status and cough |
| 2 | Patient H: Laryngeal TB is
highly infectious; hoarseness is a symptom of TB disease in that site. The larynx can also be a secondary site for
pulmonary TB, indicating need for a TB interview. In addition, even though the laryngeal smear is acid-fast
bacillus (AFB) negative, this does not give an indication of decreased infectiousness. Laryngeal smears often are AFB
negative. |
| 3 | Patient C: Infectious due to cavitary disease, TB symptoms, particularly cough |
| 4 | Patient F: While lymph node TB is extrapulmonary and not infectious in itself, the fact that bacilli were aerosolized, which is the route in which TB is transmitted, makes this patient medium priority. |
| 5 | Patient B: This patient is not infectious. However, since the patient is a 3-year-old child, this indicates that the child is recent infected and that the infectious source case may be easily located. |
| 6 | Patient D: This patient is not
highly infectious because of lack of symptoms, noncavitary disease, and negative smear status. The patient was just
diagnosed with pulmonary TB disease and should now be interviewed for that reason. |
| 7 | Patient E: This patient is not
very infectious due to having noncavitary disease, having negative smears and cultures, and being asymptomatic.
The patient does have indications of pulmonary TB due to initially having infiltrates and a positive response to TB
treatment; therefore, she should be interviewed. |
| 8 | Patient G: While this patient has TB symptoms, the recent history of atypical mycobacterial disease makes the final diagnosis more likely to be non-TB disease. The patient should still be interviewed due to having a positive culture, symptoms, and abnormal chest X-ray. Eventually, however, if the culture results in nontuberculosis mycobacteria, the contact investigation process should end. |
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