Tuberculosis Policy and Procedure Manual 2012 Georgia Department of Public Health Division of Health Protection Tuberculosis Program http://www.health.state.ga.us Georgia Tuberculosis Policy and Procedure Manual 2012 1 [THIS PAGE INTENTIONALLY LEFT BLANK] Georgia Tuberculosis Policy and Procedure Manual 2012 2 TABLE OF CONTENTS INTRODUCTION .................................................................................................................................. 5 RESPONSIBILITIES FOR TB CONTROL .......................................................................................... 7 MISSION ............................................................................................................................................ 7 Legislative authority ........................................................................................................................... 7 RESPONSIBILITY OF THE STATE TB PROGRAM ..................................................................... 7 RESPONSIBILITY OF THE DISTRICT TB PROGRAM ............................................................... 9 RESPONSIBILITY OF THE COUNTY TB PROGRAM ............................................................... 12 TUBERCULOSIS MEDICAL RECORDS .......................................................................................... 15 Retention of Medical Records .......................................................................................................... 15 SURVEILLANCE ................................................................................................................................ 17 Reporting requirements .................................................................................................................... 17 Reporting and Counting Cases of M. tuberculosis ........................................................................... 17 Criteria for TB Suspect ..................................................................................................................... 17 Case Definitions ............................................................................................................................... 18 Reporting Latent TB Infection (LTBI) ............................................................................................. 19 SENDSS Reporting Requirements and Timelines ........................................................................... 19 Other TB Program Reporting Requirements and Timelines ............................................................ 20 Interjurisdictional Transfers ............................................................................................................. 20 REFUGEE OR IMMIGRANT CLASS B1 OR B2 .............................................................................. 23 Instructions to County Health Departments on Class B1 or B2 notifications .................................. 23 B1/B2 SENDSS Processing Procedures for District TB Coordinators ............................................ 23 SENDSS Data Entry for Class B1/B2 .............................................................................................. 24 TB Alien Follow-up Worksheet Completion ................................................................................... 24 Electronic Disease Notification System Quality Improvement procedures ..................................... 24 NATIONAL TB INDICATORS .......................................................................................................... 25 TUBERCULOSIS SERVICES ............................................................................................................ 29 Medical Care .................................................................................................................................... 29 Home visits ....................................................................................................................................... 31 Administration of tuberculin skin tests (TST) or Interferon Gamma Release Assay (IGRA) ......... 31 Reading TSTs ................................................................................................................................... 31 Chest X-rays ..................................................................................................................................... 32 Other imaging and/or necessary medical procedures ....................................................................... 32 Laboratory testing ............................................................................................................................. 32 Contact Investigation ........................................................................................................................ 33 Incentives and Enablers .................................................................................................................... 34 Georgia Tuberculosis Policy and Procedure Manual 2012 3 Medical Interpretation Services ........................................................................................................ 34 Hospitalization .................................................................................................................................. 34 Court-ordered treatment and/or confinement of non-adherent TB patients ..................................... 34 Housing homeless clients ................................................................................................................. 37 State TB Social Services .................................................................................................................. 37 Program Evaluation .......................................................................................................................... 38 Directly Observed Therapy (DOT) .................................................................................................. 38 Medications ...................................................................................................................................... 39 PHARMACY ....................................................................................................................................... 41 Transport of dangerous drugs ........................................................................................................... 41 340B Information and Drug Dispensing Procedure ......................................................................... 41 Medications requiring consultation with and approval by State Medical Consultant ...................... 41 LABORATORY TESTS ...................................................................................................................... 43 MYCOBACTERIOLOGY LABORATORY TESTS .......................................................................... 67 COMMITMENT TEMPLATES .......................................................................................................... 81 AMERICAN LUNG ASSOCIATION FORMS ................................................................................ 105 RESOURCES and REFERENCES .................................................................................................... 115 Georgia Tuberculosis Policy and Procedure Manual 2012 4 INTRODUCTION These guidelines were created to assist state, district and local health departments in controlling, monitoring, treating, notifying, and testing tuberculosis (TB) disease and infection for the State of Georgia. It is not possible for any guideline to address all situations for individuals; therefore, clinical judgment must always be exercised. Tuberculosis standards have been well established by nationally accepted scientific authorities, such as the American Thoracic Society (ATS), the Infectious Diseases Society of America (IDSA) and the U.S. Centers for Disease Control and Prevention (CDC), as well as generally recognized TB control experts such as the National Tuberculosis Nurse Coalition (NTNC) and National Tuberculosis Controllers Association (NTCA). The standards of care for the medical treatment and control of TB are published jointly by ATS, IDSA, and CDC. Georgia follows these national standards and recommendations and in addition, has state-specific standards for TB control and prevention. References to these standards are listed below: Nurse Protocols for Registered Professional Nurses in Public Health, current edition. Located on the TB web pages at http://www.health.state.ga.us/programs/nursing/publications.asp Georgia Tuberculosis Reference Guide, current edition. Located on the TB web pages at http://www.health.state.ga.us/programs/tb/publications.asp NTCA, NTNC. Tuberculosis Nursing: A Comprehensive Guide to Patient Care, Second Edition.2011. Each district health office and county health department was sent a copy in 2012. Additional copies may be purchased by contacting the National TB Controllers Association at http://tbcontrollers.org/ CDC. Core Curriculum on Tuberculosis: What the Clinician Should Know, 2011. Each district health office was sent a copy in 2012. It can also be ordered from CDC or downloaded at http://www.cdc.gov/tb/education/corecurr/ ATS, CDC, IDSA. “Treatment of Tuberculosis” (MMWR 2003;52[No. RR-11]). Available at: http://www.cdc.gov/mmwr/PDF/rr/rr5211.pdf . CDC, NTCA. “Guidelines for the Investigation of Contacts of Persons with Infectious Tuberculosis: Recommendations from the National Tuberculosis Controllers Association and CDC” (MMWR 2005;54 [No. RR-15]). Available at: http://www.cdc.gov/mmwr/pdf/rr/rr5415.pdf