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Effective TB Interviewing for Contact Investigation: Self-Study Modules

Return to Module 1 Table of Contents

Case Presentations

The following case presentations apply concepts from this module. You may review them with your supervisor if you have questions.

Case 1

Part 1 – Melvin is a 38-year-old man who needs to be interviewed in the hospital. He was admitted 2 days ago with a diagnosis of pulmonary TB and is highly infectious. You walk into the room, wearing appropriate respiratory protection, to meet Melvin. He is awake but looks very tired and is coughing frequently. You introduce yourself and he acknowledges your presence. When you offer your hand, Melvin shakes it weakly.

Under circumstances like this, should you start the interview process? Why or why not? If so, what information should you include in your introduction?

Explanation: The patient may not be able to fully complete the interview process due to his physical condition. However, since it is required that you initiate the TB interview within 3 days of the report of a TB suspect, you should

  • Introduce yourself as a representative of the TB control program or health department
  • State that you are there to answer any of the patient’s questions and concerns and find out to whom he may have transmitted TB
  • Explain that the reason you are wearing respiratory protection is that he is infectious and that this will not be necessary once his symptoms improve and he starts to feel better

Part 2 – You introduce yourself to Melvin and acknowledge that he is not feeling well, and you will try to make this process as comfortable for him as you can. Melvin states that it is all right to speak with him. So, you proceed with the interviewing process.

Melvin coughs throughout the interview. What should you do while this occurs?

Explanation: See if Melvin is covering his mouth while coughing. This is a good time to provide education about infection control. If the patient covers his mouth as he coughs, provide positive feedback by saying, “Thanks for covering your mouth while coughing. Even though this is a hospital room, it is good to get into the habit of covering your mouth. That’s a good way to prevent the spread of TB.” If Melvin does not cover his mouth, gently remind him, “I understand that you don’t feel very well, but it is a good idea to get into the habit of covering your mouth when you cough. This is the best way to prevent spreading TB germs to others.” While Melvin coughs, wait before proceeding with any discussion or questions. You should also ask if he needs anything to make him feel more comfortable, such as a glass of water.

Part 3 – You and Melvin are having a productive discussion. While you are eliciting contacts’ names, he begins to lose eye contact with you. He seems to be nodding his head but does not say much.

What may Melvin’s behavior indicate? What should you do?

Explanation: Melvin may be becoming tired and his interest in the interview could be dwindling. You should ask open-ended questions, which require more than one-word answers to determine how much Melvin can answer. If he continues to not say much or responds to questions inappropriately, you should address this possible fatigue and lack of interest. Ask, “You seem to be getting tired. Is it all right if we continue, or shall we try again tomorrow?” If he states that he cannot continue the interview, determine a time to come back and continue the following day.

Case 2

Part 1 – Jane is a 35-year-old woman who has been hospitalized with pulmonary TB. You conducted a TB interview during her stay. During the interview, Jane mentioned that she lives with her husband and 13-year-old daughter. She also told you about her workplace and social contacts. At the end of her interview, you told Jane that you would visit her at home after her discharge to talk with her further. Jane has asked you why you need to talk with her again, because she feels she has given you adequate information.

How should you explain to Jane the importance of a re-interview?

Explanation: Explain to Jane, “Sometimes patients may remember other information after leaving the hospital. That is why it is routine to interview a patient at home after discharge.” You can also tell her, “It will help me to see your home to decide further steps to take in testing your contacts.” This can include confirming the details of her home’s environment. Jane can also be told that you can answer any additional questions while you are there.

Part 2 – Jane was discharged 2 weeks later. You go to her home to conduct a re-interview.

What should you look for in the home upon entry and while you are inside regarding additional contacts and formulating a testing plan?

Explanation: When you walk into the home, you should be aware of anything that may indicate the presence of the people who live there. Begin by looking at the type and number of personal items around the house. For instance, this may include the type and number of shoes, coats, pictures, trophies, and plaques. You may find evidence that additional people are present or visit the home. Regarding the testing plan, your health department resources and standards of practice may influence the plan for evaluating household contacts.

Part 3 – As you walk into the home, you notice a pair of shoes that seem to be too small for any of the household members. Inside the house, you see a picture on the fireplace mantle of a woman and a small child. You also see a teddy bear.

Since you suspect there may be other unnamed contacts, how do you ask Jane about other people?

Explanation: You should proceed with the re-interview process as you would in any other situation. Ask Jane about any information she might have forgotten to give you, including people who spent time at her house during her infectious period. If she does not mention anything about a child, you can start by talking about the picture by saying, “By the way, I noticed the picture on the mantle. Who is the child in the picture?” Once the child’s identity has been established, you can ask, “Oh, that’s your sister’s child? Are you lucky enough to see her often?” If the line of questioning does not yield helpful information, you should be more direct. Simply ask about the shoes by saying, “I also noticed a pair of small child’s shoes in the front and was wondering if they belong to a child who comes to visit frequently. It is important that we know, since children can become seriously ill if infected with TB.”

 
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