Self-Study Modules on Tuberculosis
Module 8: Tuberculosis Surveillance and Case Management in Hospitals
In this module, you will learn about the role of public health
workers (e.g., public health advisors, DOT outreach workers) in
conducting tuberculosis (TB) surveillance and case management in
hospitals or institutional settings. This module will familiarize
you with a systematic process for managing TB patients in these
settings. The process begins with the identification of suspected
or confirmed TB cases by routine case reporting and by active case
finding through periodic visits to laboratories and pharmacies.
Active case finding and routine case reporting are followed by the
collection of patient information from medical records and other
sources. This information prepares the public health worker for
an initial interview that is used to establish the basis for a good
relationship with the patient, to begin a contact investigation,
and to assess the patient's individual needs. Finally, you will
learn about planning for a patient's follow-up care while in the
facility and after discharge.
Keep in mind that the duties of public health workers vary
from situation to situation. Often, a public health worker is assigned
to a hospital or institution to assist in surveillance activities
and case management duties. The resources of many TB programs may
not be adequate to support the broad range of activities recommended
in this module; however, it may be appropriate in some areas to
target specific hospitals or institutions or specific public health
functions, according to local needs. This module is therefore intended
to present an overview of public health duties related to TB control
in hospital and institutional settings; it does not advocate specific
duties and functions for individuals.
After working through this module, you will be able to:
- Explain the primary goals of TB prevention and control.
- Describe the process of conducting TB surveillance and case
management in hospitals and institutions.
- Explain the importance of good communication with patients and
with hospital or institutional staff.
- Describe specific considerations for conducting TB surveillance
and case management in correctional facilities.
- List the hospital or institutional staff with whom the public
health workers may collaborate.
- Describe how public health workers support hospital or institutional
staff in the care of patients with TB.
- Discuss the case definition and criteria for the classification
of suspected and confirmed TB cases.
- Explain the two basic methods for identifying suspected or confirmed
TB cases and how they are put into practice.
- Explain how to use information found in laboratories and pharmacies
- Explain how to locate the patient and identify available information
- Discuss the importance of the initial patient interview.
- Explain how to assess the patient's potential for adherence.
- Describe the seven main sections of the patient's medical record.
- Describe the responsibility of the TB program to every suspected
or confirmed TB case.
- Describe the purpose of planning for discharge from the facility.
- Describe how information is gathered about patients who are
discharged, leave the facility, or die.
- Describe procedures that should be used in the interjurisdictional
referral of patient information.
Lists of new terms were introduced in each of the five core Self-Study
Modules on Tuberculosis (Modules 1-5). Please refer to the
core modules or their Glossary if you encounter unfamiliar terms
related to TB that are not defined in this New Terms section.
Look for the following new terms in this module.
action plan - a plan to determine what information
is missing or pending, where and when to collect this information,
and who will need the information
active case finding - identifying unreported cases
of TB disease by actively searching for them through, for example,
laboratory and pharmacy audits
adherence plan - a written plan that is based
on the patient's understanding and acceptance of the TB diagnosis,
that addresses barriers to adherence, and that details the method
chosen to deliver treatment and monitor adherence for that specific
admission note - patient information recorded
at the time of admission to a hospital, usually including the admission
diagnosis and initial plan for diagnostic work-up; usually included
in the progress notes
AFB logbook - a logbook kept in the mycobacteriology
laboratory that contains the results of acid-fast bacilli (AFB)
smear examinations; it may be called a smear mycobacteriology log
case management - a system in which a specific
health department employee is assigned primary responsibility for
the patient, systematic regular review of patient progress is conducted,
and plans are made to address any barriers to adherence
discharge planning - the preparation of a detailed
plan for comprehensive care of a hospitalized or institutionalized
patient after that patient's discharge
discharge summary - a document written by the
patient's physician upon discharge; contains a brief summary of
all important information from the entire hospitalization or stay
in the institution, including the discharge diagnosis and often
a plan for follow-up care
emergency room/department assessment form - patient
information recorded when a patient is brought to an emergency room;
may be used instead of an admission note and is usually included
in the progress notes
first-line TB drugs - the initial drugs used for
treating TB disease. Include isoniazid (INH), rifampin (RIF), pyrazinamide
(PZA), and either ethambutol (EMB) or streptomycin (SM)
history and physical exam form - a standardized form sometimes
used to record patient information at the time of the patientís
first evaluation; may be used instead of an admission note and is
usually included in the progress notes; it is also referred to as
hospital epidemiologist - a specially trained person who
studies the causes of outbreaks and other health problems in a health
identification data - includes the patientís name, address,
social security number, date of birth, and other demographic information
(may be a separate registration form)
infection control practitioner - a trained health care
professional (often a nurse) who is responsible for controlling
and preventing the spread of infectious diseases in a hospital or
other health care setting
institutions - residential facilities where groups of people
live, such as nursing homes, correctional facilities, or homeless
shelters, as well as out-patient facilities, such as drug treatment
centers or health department clinics
laboratory results - records presenting the results of
every laboratory test that has been done on the patient, such as
AFB smear examinations, cultures, and drug susceptibility tests
performed in a laboratory
latent TB infection (LTBI) - also referred to as TB infection.
Persons with latent TB infection carry the organism that causes
TB but do not have TB disease, are asymptomatic, and noninfectious.
Such persons usually have a positive reaction to the tuberculin
medical records department - a department in a hospital
or other health care facility that houses the records of patients
who have been admitted to the hospital and subsequently have been
discharged, transferred to ambulatory care services, left against
medical advice, or died
medication record - an information sheet on which the nurses
record the date, time, and amount of prescribed medications given
to the patient during hospitalization or care in a facility; may
not be included in patientís medical record (for example, may be
kept in a separate medication logbook)
nursesí notes - a record in which the nurses who directly
care for the patient continuously record information, including
the patientís symptoms, medications given, and scheduled procedures
or activities and may be included in the progress notes section
out-patient clinic - a clinic that cares for non-hospitalized
patients with a particular type of problem (for example, chest,
infectious disease, AIDS, pediatric)
pathology laboratory - a laboratory that performs tests
and examinations on tissue and biopsy specimens
physicianís orders - a record in which the physician(s)
prescribes medications, orders laboratory tests or procedures (for
example, bronchoscopy or gastric aspiration), and delivers other
patient-care instructions to staff. Medication orders specify date,
name of medication, dosage, and duration of treatment (in days or
in number of doses)
progress notes - a record in which all physicians and other
specialists continuously record patient information during a patientís
hospital stay and may include nursesí notes and notes from other
public health worker - an employee of the health department
(often a public health advisor, DOT outreach worker, or a nurse)
whose duties may include either surveillance, case management, or
some combination of these activities
radiology reports - reports summarizing all radiology procedures
performed on the patient (for example, chest radiographs or CT scans);
part of the medical record
routine case reporting - the required reporting
of suspected or confirmed TB cases to a public health authority
second-line TB drugs - drugs used to treat TB
that is resistant to first-line TB drugs (for example, capreomycin,
kanamycin, ethionamide, cycloserine, ciprofloxacin, amikacin)
SOAP notes - Progress notes can also be referred
to as SOAP notes: subjective progress, objective progress, assessment,
surveillance - the ongoing systematic collection,
analysis, and interpretation of health data essential to the planning,
implementation, and evaluation of public health practice, closely
integrated with the timely dissemination of these data to those
who need to know in public health programs
treatment plan - a written plan detailing the
medical regimen as ordered by the physician, including periodic
monitoring for adverse reactions and other follow-up care