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Montgomery County TB Control Program Mission Statement <ul><li>The mission of the TB Control Program is to </li></ul><ul><...
What is tuberculosis (TB)? <ul><li>Tuberculosis (TB) is a disease caused by bacteria called Mycobacterium tuberculosis tha...
Latent TB Infection <ul><li>TB bacteria can live in your body without making you sick. This is called  latent TB infection...
TB Disease <ul><li>TB bacteria become active if the immune system can't stop them from growing. When TB bacteria are activ...
The Difference between Latent TB Infection and TB Disease <ul><li>Needs treatment to treat active TB disease </li></ul><ul...
Epidemiology of TB in the U.S.A.
Data and Statistics   Tuberculosis (TB) is one of the world’s deadliest diseases: One third of the world’s population are ...
Treatment for Latent TB Infection (LTBI) DOPT <ul><li>People with  latent TB infection  have TB germs in their bodies, </l...
Treatment for TB Disease - DOT <ul><li>A person with  active TB disease  has a large amount of TB </li></ul><ul><li>bacter...
CONTACT OF INVESTIGATION DEFINITION <ul><li>A &quot;Contact&quot; is a person of any age who has been in close association...
Annotated Code of Maryland, Health – General  §§18-324 <ul><li>Examination  – The Secretary or a health </li></ul><ul><li>...
OSHA Guidelines <ul><li>The Occupational Safety and Health Administration (OSHA) </li></ul><ul><li>estimates that as many ...
Montgomery County Shelter Guidelines Administrative TB Exposure Plan <ul><li>The TB exposure determination and procedure f...
Shelter Guidelines – cont. <ul><li>For clients with  TB symptoms arrangement must be made to referred to the TB control cl...
<ul><li>Attachment B </li></ul><ul><li>Dennis Avenue Health Center </li></ul><ul><li>TB Control Program </li></ul><ul><li>...
<ul><li>Attachment C </li></ul><ul><li>Dennis Avenue Health Center </li></ul><ul><li>TB Control Program </li></ul><ul><li>...
<ul><li>Attachment A </li></ul><ul><li>HHS Contacts </li></ul><ul><li>Dennis Avenue Health Center (DAHC)2000 Dennis Avenue...
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HOME Conference 2010 - Update on TB Transmissions

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By Yvonne Richards, Joan Gorena and Barbara Golding

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Transcript of "HOME Conference 2010 - Update on TB Transmissions"

  1. 1. Montgomery County TB Control Program Mission Statement <ul><li>The mission of the TB Control Program is to </li></ul><ul><li>protect the public health by assuring early </li></ul><ul><li>identification and treatment of tuberculosis </li></ul><ul><li>disease and to decrease the reservoir of </li></ul><ul><li>possible TB infection by providing treatment </li></ul><ul><li>for latent TB infection for those at risk of </li></ul><ul><li>developing active tuberculosis disease. </li></ul>
  2. 2. What is tuberculosis (TB)? <ul><li>Tuberculosis (TB) is a disease caused by bacteria called Mycobacterium tuberculosis that are spread from person to person through the air. TB usually affects the lungs, but it can also affect other parts of the body, such as the brain, the kidneys, or the spine. Not everyone infected with TB bacteria becomes sick. As a result, two TB-related conditions exist: latent TB infection and active TB disease. </li></ul>
  3. 3. Latent TB Infection <ul><li>TB bacteria can live in your body without making you sick. This is called latent TB infection (LTBI) . In most people who breathe in TB bacteria and become infected, the body is able to fight the bacteria to stop them from growing. People with latent TB infection do not feel sick and do not have any symptoms. The only sign of TB infection is a positive reaction to the tuberculin skin test or special TB blood test . People with latent TB infection are not infectious and cannot spread TB bacteria to others. However, if TB bacteria become active in the body and multiply, the person will get sick with TB disease. </li></ul>
  4. 4. TB Disease <ul><li>TB bacteria become active if the immune system can't stop them from growing. When TB bacteria are active (multiplying in your body), this is called TB disease . TB disease will make you sick. People with TB disease may spread the bacteria to people they spend time with every day. Many people who have latent TB infection never develop TB disease. Some people develop TB disease soon after becoming infected (within weeks) before their immune system can fight the TB bacteria.  Other people may get sick years later, when their immune system becomes weak for another reason. </li></ul><ul><li>For persons whose immune systems are weak, especially those with HIV infection, the risk of developing TB disease is much higher than for persons with normal immune systems </li></ul>
  5. 5. The Difference between Latent TB Infection and TB Disease <ul><li>Needs treatment to treat active TB disease </li></ul><ul><li>Needs treatment for latent TB infection to prevent active TB disease </li></ul><ul><li>May have an abnormal chest x-ray, or positive sputum smear or culture </li></ul><ul><li>Has a normal chest x-ray and a negative sputum smear </li></ul><ul><li>Usually has a skin test or blood test result indication TB infection </li></ul><ul><li>Usually has a skin test or blood test result indicating TB infection </li></ul><ul><li>May spread TB bacteria to others </li></ul><ul><li>Cannot spread TB bacteria to others </li></ul><ul><li>Usually feels sick </li></ul><ul><li>Does not feel sick </li></ul><ul><li>Has symptoms that may include : </li></ul><ul><li>A bad cough that last 3 weeks or longer </li></ul><ul><li>Pain in the chest </li></ul><ul><li>Coughing up blood or sputum </li></ul><ul><li>Weakness or fatigue </li></ul><ul><li>Weight loss </li></ul><ul><li>No appetite </li></ul><ul><li>Chills </li></ul><ul><li>Fever </li></ul><ul><li>Sweating at night </li></ul><ul><li>Has no symptoms </li></ul>A Person with TB Disease A Person with latent TB
  6. 6. Epidemiology of TB in the U.S.A.
  7. 7. Data and Statistics Tuberculosis (TB) is one of the world’s deadliest diseases: One third of the world’s population are infected with TB. Each year, over 9 million people around the world become sick with TB. Each year, there are almost 2 million TB-related deaths worldwide. TB is a leading killer of people who are HIV infected. In total, 12,904 TB cases (a rate of 4.2 cases per 100,000 persons) were reported in the United States in 2008. Both the number of TB cases reported and the case rate decreased; this represents a 2.9% and 3.8% decline, respectively, compared to 2007. 219 3.8 278 4.9 270 4.5 2009 Cases Rate 2008 Cases Rate 2007 Cases Rate MARYLAND 70 7.2 88 9.3 82 8.8 2009 Cases Rate 2008 Cases Rate 2007 Cases Rate MONTGOMERY COUNTY
  8. 8. Treatment for Latent TB Infection (LTBI) DOPT <ul><li>People with latent TB infection have TB germs in their bodies, </li></ul><ul><li>but they are not sick because the germs are not active. </li></ul><ul><li>However, they may develop TB disease in the future. They </li></ul><ul><li>are often prescribed treatment to prevent them from </li></ul><ul><li>developing TB disease. Usually, only one drug is needed to </li></ul><ul><li>treat latent TB infection. The medicine usually taken for the </li></ul><ul><li>treatment of latent TB infection is called Isoniazid (INH). </li></ul><ul><li>INH for 9 months is the preferred regimen or Rifampin for 4 </li></ul><ul><li>to 6 months. These drugs kill the TB bacteria that are in the </li></ul><ul><li>body. </li></ul>
  9. 9. Treatment for TB Disease - DOT <ul><li>A person with active TB disease has a large amount of TB </li></ul><ul><li>bacteria in the body. TB disease can be treated by taking </li></ul><ul><li>several drugs for 6 to 12 months or longer. It is very </li></ul><ul><li>important that people who have TB disease finish the </li></ul><ul><li>medicine, and take the drugs exactly as prescribed. If they </li></ul><ul><li>stop taking the drugs too soon, they can become sick again; </li></ul><ul><li>if they do not take the drugs correctly, the germs that are still </li></ul><ul><li>alive may become resistant to those drugs. TB that is </li></ul><ul><li>resistant to drugs is harder and more expensive to treat. </li></ul>
  10. 10. CONTACT OF INVESTIGATION DEFINITION <ul><li>A &quot;Contact&quot; is a person of any age who has been in close association with an active case of TB. An infected contact is a person who over a sufficient length of time has become infected with M. tuberculosis by breathing the contaminated air. </li></ul><ul><li>The goal of a tuberculosis contact investigation is both to identify other active cases of tuberculosis and to identify and complete treat individuals with new latent TB infection. </li></ul><ul><li>Tuberculosis contact investigation is required for all pulmonary TB cases in Maryland . </li></ul>
  11. 11. Annotated Code of Maryland, Health – General §§18-324 <ul><li>Examination – The Secretary or a health </li></ul><ul><li>officer may have an individual examined, if </li></ul><ul><li>the Secretary or the health officer knows or </li></ul><ul><li>is notified in writing by a physician that the </li></ul><ul><li>individual is suspected of having tuberculosis. </li></ul>
  12. 12. OSHA Guidelines <ul><li>The Occupational Safety and Health Administration (OSHA) </li></ul><ul><li>estimates that as many as 13 million adults in the United </li></ul><ul><li>States are currently infected with TB and that 5 million </li></ul><ul><li>workers are exposed. The purpose of the OSHA’s standard </li></ul><ul><li>is to reduce these risks in health care and other work settings </li></ul><ul><li>where active TB cases are likely to be encountered by </li></ul><ul><li>employees. Homeless shelters have been defined as one </li></ul><ul><li>of these facilities meeting the scope of occupational </li></ul><ul><li>exposure to TB, along with hospitals, extended care </li></ul><ul><li>facilities, and mycobacterium laboratories to name a few. </li></ul><ul><li>Since the shelters in Montgomery County meet the above guidelines and in </li></ul><ul><li>addition had 0 -2 cases of TB diagnosed in the shelters over 12 years, the </li></ul><ul><li>following recommendations are proposed to maintain appropriate TB control </li></ul><ul><li>measures in the shelter environment. </li></ul>
  13. 13. Montgomery County Shelter Guidelines Administrative TB Exposure Plan <ul><li>The TB exposure determination and procedure for reporting an exposure is as follows: </li></ul><ul><li>A person with a cough lasting for more than three weeks in addition to at least two other symptoms such as fevers, night sweats and weight loss must be referred to Stella Akuchie, CHN, Homeless TB Nurse Coordinator by calling (240) 777 - 1832 or 1800 for advice. </li></ul><ul><li>All TB suspects or any individual with a cough must be instructed to cover his/her mouth and nose with a tissue when coughing or cough in their sleeves and must be instructed in the proper disposal of tissues. </li></ul><ul><li>Procedure for transferring individuals with suspected TB: </li></ul><ul><li>The individual with suspected TB may be transported to the nearest hospital by calling 911 services with prior notification of respiratory precautions to ambulance attendees. </li></ul><ul><li>Procedure for informing employees of exposure if a client or staff member is diagnosed with TB : </li></ul><ul><li>The TB Control Nurse Administrator will inform the Shelter Administrator of the possibility of any exposure, work on a plan to inform affected individuals and provide TB screening. Remember the confidentiality of the active case must be maintained as well as the confidentiality of the exposed person. </li></ul><ul><li>Provide information and training to employees </li></ul>
  14. 14. Shelter Guidelines – cont. <ul><li>For clients with TB symptoms arrangement must be made to referred to the TB control clinic immediately. If after hours referred to the Emergency room or to appropriate ventilated housing. </li></ul><ul><li>.Shelter staff can admit client with suspected or confirmed TB under the following circumstance: clients who are receiving appropriate anti - tb chemotherapy under Directly Observed Therapy, with laboratory confirmation of negative smears and cultures or with clinical improvement or chest x- ray improvement. In addition client must have appropriate documented clearance from the TB Control Medical Director </li></ul>
  15. 15. <ul><li>Attachment B </li></ul><ul><li>Dennis Avenue Health Center </li></ul><ul><li>TB Control Program </li></ul><ul><li>2000 Dennis Ave. </li></ul><ul><li>Silver Spring, MD 20902 </li></ul><ul><li>240-777-1800 </li></ul><ul><li>TB Symptom Check List </li></ul><ul><li>Date: _______________________ </li></ul><ul><li>Name of Client: _____________________ ______________________ _____________ </li></ul><ul><li>Last Name First Name Service Point ID </li></ul><ul><li>Current cough for more than 3 weeks? Yes No </li></ul><ul><li>Are you coughing up blood Yes No </li></ul><ul><li>Fever or chills for more than 3 weeks? Yes No </li></ul><ul><li>Do you have night sweats Yes No </li></ul><ul><li>Unexplained weight loss of 10lbs. or more? Yes No </li></ul><ul><li>Have you ever been told that you have TB? Yes No </li></ul><ul><li>Have you ever been treated for TB? Yes No </li></ul><ul><li>Anyone with a cough lasting more than 3 more than weeks and answered yes to any of the remaining questions (#2-6) is to be referred to the TB Clinic at Dennis Avenue. Call Dennis Ave. TB Clinic 240-777-1800 for an appointment; complete the TB Control Program Referral Form with this form and provide copies for the client to take with them to their appointment at the Dennis Ave. TB Clinic. </li></ul><ul><li>Staff Person: _____________________________ _______________________________ </li></ul><ul><li>Completing First Name Last Name </li></ul><ul><li>Form </li></ul>
  16. 16. <ul><li>Attachment C </li></ul><ul><li>Dennis Avenue Health Center </li></ul><ul><li>TB Control Program </li></ul><ul><li>2000 Dennis Ave. </li></ul><ul><li>Silver Spring, MD 20902 </li></ul><ul><li>240-777-1800 </li></ul><ul><li>TB Screening Referral Form </li></ul><ul><li>Date: _________________________ </li></ul><ul><li>Name of Shelter: ____________________________ </li></ul><ul><li>Name of Client: _________________________ _____________________ ______________________ </li></ul><ul><li>First Name Last Name Service Point ID </li></ul><ul><li>TB Screening Appointment: _________________________________ ____________________ </li></ul><ul><li>Date Time </li></ul><ul><li>The above named client is seeking shelter and does not have a current TB clearance on file in ServicePoint. Please screen this client for TB. </li></ul><ul><li>Information about the TB Clinic </li></ul><ul><li>Appointments: TB Screenings are by Appointment Only Call 240-777-1800 for an appointment </li></ul><ul><li>Clinic Hours are Monday thru Friday 8A-12N, closed 12-1P for lunch, 1P-3P except on Wed. 2-3:30P </li></ul><ul><li>Location: 2000 Dennis Avenue Silver Spring, MD 20902 </li></ul><ul><li>Directions: At Georgia Avenue and Dennis Avenue, the Health Clinic is located 2 blocks from the intersection, on Dennis Avenue on the right </li></ul><ul><li>Metro Bus lines Y7, Y8 and Q2 all stop at Georgia Avenue and Dennis Avenue </li></ul><ul><li>Take this Referral Sheet to your appointment </li></ul><ul><li>TB Screenings must be completed within 4 days of admission to the shelter </li></ul>
  17. 17. <ul><li>Attachment A </li></ul><ul><li>HHS Contacts </li></ul><ul><li>Dennis Avenue Health Center (DAHC)2000 Dennis AvenueSilver Spring, MD </li></ul><ul><li>20902 </li></ul><ul><li>Yvonne Richards, RN, Manager, TB Outreach and Case Management 240-777-1798 </li></ul><ul><li>Cindy Edwards, RN, MHCA, Manager, Disease Control Program240-777-1024 </li></ul><ul><li>Health Care for Homeless (HCH)11 North Washington StRockville, MD </li></ul><ul><li>20850 </li></ul><ul><li>Ellen Brown, RN, LCSW-C, Manager, Health Care for the Homeless 240-777-3963 office </li></ul><ul><li>240-370-7717 cell </li></ul><ul><li>Vacant Position, Nurse Case Manager HCH240-777-XXXX office Special Needs Housing Homeless </li></ul><ul><li>Services - 1301 Piccard DriveRockville, MD 20851 </li></ul><ul><li>Kim Ball HHS Special Needs HousingAdministrator, Homeless </li></ul><ul><li>Services 240-777-4125 office, 240-372-8451 cell </li></ul><ul><li>Tanya Jones LCSW-C, Shelter Coordinator for Single Adults240-777-4151 </li></ul>
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