Self-Study Modules on Tuberculosis
Module 8: Tuberculosis Surveillance and Case Management in Hospitals
TB in Correctional Facilities
This module addresses TB surveillance and case management in hospitals
and institutions in general. However, because of the unique challenges
posed by controlling TB in correctional facilities, a brief overview
of the health department's and correctional facilities' role in
TB surveillance and case management follows.
TB poses a particular challenge today in correctional environments
(Figure 8.2 and Figure 8.3), as inmate populations increase and
overcrowding makes outbreaks of TB a serious threat. Control of
TB is an essential element in correctional health care.
All correctional facilities--even facilities in which few cases
of TB are expected--should have a written TB infection control plan
and should designate a person or group of persons who will be responsible
for the TB infection control program in the facility.
State and local health departments should form close working relationships
with correctional facility officials. Health departments can assist
correctional facilities in formulating, implementing, and evaluating
essential TB control activities.
Figure 8.2 Correctional facility intake.
This is a picture of a correctional facility intake area
Figure 8.3 Correctional facility.
This is a picture of a correctional facility ward.
Role of the Health Department
Health departments should assist correctional facilities in developing
and updating policies, procedures, and record systems for TB control.
The health department should also provide access to expert TB medical
consultation and ensure that correctional facilities have access
to adequate laboratory services. A specific health department contact
person should be designated to provide epidemiologic and management
assistance to correctional facilities. This responsibility may initially
require considerable onsite consultation at the correctional facility.
Small jails may need more direct support from the health department.
For instance, it may be possible for health department staff to
perform screening activities or administer directly observed therapy
Health department staff should help develop programs to train correctional
facility staff to
- Create TB control policies and procedures
- Perform, read, and record tuberculin skin tests (Figure 8.4)
- Identify signs and symptoms of TB disease
- Initiate and observe therapy
- Monitor medication side effects
- Collect diagnostic specimens
- Educate inmates
- Maintain record systems
- Provide tracking and patient record system
- Ensure released inmates complete therapy
Figure 8.4 Correctional facility nurse administering a tuberculin
skin test at intake.
This is a picture of a correctional facility nurse administering
a tuberculin skin test at intake.
Health departments should also provide consultation for contact
investigations for each case within correctional facilities and
ensure appropriate examinations for community contacts of the persons
found to have TB in these facilities. In addition, health departments
should cooperate with correctional staff in identifying TB among
persons who enter the facility and arranging continued treatment
for inmates released while receiving TB treatment or treatment for
Health departments have a responsibility to maintain TB registries
with updated medical information on all current TB patients in their
jurisdictions, including persons in correctional facilities. Cross-matching
information from the TB registry with the names of inmates admitted
into correctional facilities can help identify persons with TB disease
who fail to report their TB history or locate patients who have
been lost. TB case records should be assessed quarterly, and necessary
revisions in policies or procedures should be recommended. In addition,
health departments should regularly collect information on TB cases
reported in correctional facility inmates and staff, and should
periodically assess the impact of TB infection and disease in correctional
facilities on the community as a whole.
Because some inmates may have both TB and HIV infection, health
department officials should assist correctional facilities in developing
and implementing HIV prevention programs. Such programs should include
strategies to identify persons practicing high-risk behaviors, to
reduce high-risk behaviors among all inmates, and to provide counseling
and testing services to HIV-infected persons.
Role of the Correctional Facility
The correctional facility should be responsible for in-facility
TB screening, containment, and assessment unless otherwise mandated
by legal statute. In all correctional facilities, officials should
work closely with the state and local health departments in the
jurisdiction. Correctional facilities, including local jails, are
advised to have formal written working agreements with the health
department in their area.
These written agreements should delineate responsibilities and
specify procedures for the following activities:
- Evaluation and treatment of inmates
- Surveillance to ensure that cases of TB are promptly reported,
counted, and recorded
- Follow-up of symptomatic inmates
- Follow-up of inmates who have abnormal chest radiologies
- Contact investigation within the facility for reported TB cases
and follow-up with the health department for contact investigation
of potentially exposed patients outside the facility
- Follow-up of inmates released before completing treatment for
- Follow-up of inmates released before completing treatment for
Correctional facilities should also collaborate with health department
staff to provide education and counseling about TB to inmates and
It may be necessary for correctional facility staff to request
health departments and receiving facilities to formally notify them
of the arrival of referred inmates on DOT who are released or transferred
into the jurisdiction. This is a very important component of a good
TB control program, since persons who are lost to follow-up are
at high risk of never completing therapy, developing drug-resistant
TB disease, and spreading TB to others. Inmates on DOT for LTBI
who are released or transferred to other correctional facilities
should also be referred for follow-up treatment.
Summary of the Role of Health Departments in TB Surveillance and
Case Management in Correctional Facilities
Health department staff should
- Designate a specific person to work with correctional facilities
- Ensure that cases of TB are promptly reported, counted, and
- Provide information from the TB registry in the health department
so that information from the TB registry can be cross-matched
with names of inmates admitted into correctional facilities to
identify persons with TB disease who fail to report their TB history
- Assist correctional facilities in developing, implementing,
- TB control policies and procedures
- Training and educational programs
- Tracking and patient record systems
- HIV prevention programs
- Ensure that released inmates complete therapy
- Assist with contact investigations in and outside correctional
- Analyze TB morbidity in correctional facilities
- Provide or refer to expert clinical consultation
- Ensure access to adequate laboratory services
|Study Questions 8.6-8.7
8.6. What are
some of the roles of the health department staff in the
surveillance and case management of TB patients in correctional
8.7. What can correctional facilities do to help ensure
completion of therapy for inmates released or referred while
being treated for infection or disease?
|Case Study 8.1
As the new public health worker at the state prison
(or in any other facility to which you are assigned), you
are asked to attend a staff meeting where you have the opportunity
to present to the administration a description of your job,
your role at the facility, and the process you use to conduct
your work. Because you suspect that the facility director
has some misunderstandings about TB control, you are quite
pleased to have this opportunity. You begin to prepare diligently
for the meeting.
- What will you tell the director about the primary goals
of TB prevention and control?
- How will you describe your role at the facility and
the process you use to conduct your work?