Self-Study Modules for Effective TB Interviewing
The following case presentations apply concepts from this module.
You may review them with your supervisor if you have questions.
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
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.
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
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
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
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.”