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Tuberculosis Control in a Large Urban Jail: Discordance Between Policy and Reality

Rutz, Heather J. MCRP, MHS; Bur, Sarah MPH, RN; Lobato, Mark N. MD; Baucom, Sharon MD; Bohle, Elizabeth MSN, CRNP, BC; Baruch, Nancy G. RN, MBA

Journal of Public Health Management & Practice: September/October 2008 - Volume 14 - Issue 5 - p 442–447
doi: 10.1097/01.PHH.0000333878.55572.ed
Article

Objective: This study evaluated adherence to tuberculosis control guidelines, published by the Centers for Disease Control and Prevention in 1996, in a large urban jail. Jails are a critical locale because of high risk for tuberculosis transmission in a congregate setting.

Methods: Symptom screening at intake into the facility was systematically observed. Medical records were reviewed to measure timing of tuberculin skin testing (TST) and chest radiograph (CXR) screening. Isolation records were examined for airborne infectious isolation practices. Contact investigation practices were evaluated for ease of data retrieval and adherence to CDC guidelines.

Results: A TB symptom screening question was asked correctly during 28/97 of intake health interviews. Median time from intake to TST was 3 days for men and 2 days for women. Median time from referral to CXR was 2 days for men and 7 days for women. Delays were noted in diagnostic testing of 51 detainees isolated for suspected TB. Contact investigations lacked comprehensive procedures, data collection forms, and databases for managing information.

Conclusion: Findings were used to refine protocols for TB control. This evaluation illustrated the need for ongoing assessment of adherence to TB control protocols in short-term correctional settings to prevent the spread of TB.

This study evaluated adherence to tuberculosis control guidelines, published by the Centers for Disease Control and Prevention in 1996, in a large urban jail.

Heather J. Rutz, MCRP, MHS, is Senior Research Program Coordinator, Maryland Department of Health and Mental Hygiene, Baltimore.

Sarah Bur, MPH, RN, is a Public Health Consultant, Baltimore, Maryland.

Mark N. Lobato, MD, is New England TB Consultant, Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia.

Sharon Baucom, MD, is Medical Director, Maryland Department of Public Safety and Correctional Services, Baltimore, Maryland.

Elizabeth Bohle, MSN, CRNP, BC, is Director, Communicable Diseases Program Howard County Health Department, Columbia, Maryland.

Nancy G. Baruch, RN, MBA, is Chief, Division of Tuberculosis Control, Refugee and Migrant Health, Maryland Department of Health and Mental Hygiene, Baltimore, Maryland.

Corresponding Author: Heather J. Rutz, MCRP, MHS, Maryland Department of Health and Mental Hygiene, Division of Tuberculosis Control, Refugee and Migrant Health, 201 West Preston St, Rm. 307-A, Baltimore, MD 21201 (hrutz@dhmh.state.md.us).

© 2008 Lippincott Williams & Wilkins, Inc.