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The Status of TB Prevention and Control Measures in Large City and County Jails in the U.S.

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Executive Summary

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Strengthen TB Environmental Controls and Isolation Practices

The study found that environmental controls in prescreening areas were a weak component of most of the jail systems’ TB control efforts and that delays were common in isolation of inmates suspected of having TB.

Environmental Controls in High-Risk Prescreening Areas

In 80 percent of the jail systems surveyed, the air from the intake and booking areas was recirculated to other parts of the facility. The reported average time from admission to symptom screening was close to 3 hours, but the time could extend up to 24 hours. In this length of time, other inmates and staff may be exposed to contaminated air.

Specific Recommendations

  • Evaluate and modify, if necessary, ventilation and filtration systems to strengthen TB environmental control in prescreening areas.

Immediately Isolate Inmates Who Have or Are Suspected of Having TB

Good infection control measures suggest erring on the side of caution and promptly isolating inmates with TB symptoms or abnormal chest radiographs until TB is ruled out. Although most of the jail systems had adequate policies requiring the initiation of isolation, review of medical records of inmates who were evaluated for TB disease showed that at least 14 percent had probable or definite cause for isolation but were not isolated. Furthermore, delays in isolation of at least a day occurred for 44 percent of patients with symptoms or abnormal chest radiographs.

Specific Recommendation

  • To ensure good infection control by immediately isolating these inmates, jail systems and local health department TB programs should collaboratively evaluate how long it takes from first report of TB symptoms or abnormal chest radiograph to inmate isolation, and strengthen procedures and policies accordingly.

Improve the Use and Monitoring of Airborne Infection Isolation Rooms

Nearly one third of surveyed jail systems reported at least sometimes holding inmates with suspected or confirmed TB in rooms lacking negative pressure or any other environmental controls. This was a particular problem for jail systems with no on-site airborne infection isolation rooms (40 percent of the study sample). Jail systems that have airborne infection isolation rooms need to strengthen protocols for monitoring negative pressure. Most of the jails with electronic monitors did not verify negative pressure manually with smoke tube tests.

Specific Recommendations

  • Jail systems lacking airborne infection isolation rooms need to promptly send inmates with suspected TB to hospital airborne infection isolation rooms. Jail systems regularly housing inmates at high risk for TB can also consider installing other environmental controls (e.g., HEPA filters, UVGI lighting) in an isolation room where such inmates can be held while awaiting transport to a hospital airborne infection isolation room.

  • Jail systems with on-site airborne infection isolation rooms should verify negative pressure daily when in use, using a smoke tube test.


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