TB Detectives Behind Bars

Transcription

1 TB Detectives Behind Bars A large contact investigation in a prison. Gina Frazier, RN, BSN Teresa Stallings, RN

2 NCDPS-Adult Corrections North Carolina houses approximately 38,000 inmates in 61 state prison facilities. There are prisons in 50 North Carolina counties. Inmates are moved between facilities for various reasons: processing, custody changes, medical needs, educational/ vocational opportunities, parole/release.

3 Movement within the NC DPS In 2013 per month inmates were transferred between facilities, inmates were transferred in & out to court, inmates were admitted to prison from county jails Needless to say all this movement presents challenges in a TB contact investigation

4 Investigative Tools Electronic database-opus Utilizes a systematic approach to identify inmates who need to be included in a contact investigation Consideration of infectiousness of a source case, environmental factors and co-morbidities of identified contacts are essential in a contact investigation

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9 The Investigation Begins After this list is complied, a team is put in place to screen/test the identified contacts. Depending on the number of identified contacts Outreach Nurses may be sent to help with the investigation. The Director of Clinical Health Services stops movement during the initial screenings/testing.

10 Movement of Contacts Contacts identified by the exposure report are not always still housed at the initial housing unit. Some contacts may be transferred to other prison units or even released to the community before the initial testing is completed.

11 Testing/Screening Inmates are held in from work assignments on the day of testing/screening and on the day of readings Abnormal results are referred for chest x-ray and LTBI

12 Treatment Options DOT must be used for the treatment of LTBI, as well as TB disease Treatment regimens are: INH 900 mg, B6 50 mg for 9 months/78 doses-given twice weekly INH 900 mg, Rifapentine 900 mg, B6 50 mg 12 doses within 16 weeks-given once weekly

13 Treatment Monitoring Baseline LFT & PRN as ordered by provider Reassess monthly for signs & symptoms of adverse reactions to medications

14 Second Round of Investigation Is more challenging than the first-inmates have usually moved to other units within the state or released to the community. Contacts are located, units are notified of needed repeat testing/screenings, if the inmate has released, the health department in the county of release is notified of need to test/screen

15 Contact Investigation at a Medium Custody Correctional Institution 916 inmates 8 housing units each with 4 dormitories 7 support buildings-administrative, operations, dining hall, program/chapel, recreational, educational/vocational and medical

16 Prison Source Case 39 year old Asian Male Incarcerated for 15 years History of past positive 20 mm PPD in 1998 Refused LTBI after taking only 5 doses in 1998

17 Diagnostic Clues August 2013-c/o productive cough August 2013-CXR showed small left suprahilar lung mass September 2013-Chest CT cavity in left side with nodules, possible TB September 2013-transferred to Central Prison Hospital Complex Sputa 4+ AFB smear positive, PCR positive Diagnosis of TB disease

18 Contact Investigation First round of testing/screening: 138 inmate PPD s placed 20 inmate past positive screenings 13 inmate converters-with no sx/negative CXR 1 out to court

19 Contact Investigation Second round of testing/screening: 133 inmate PPD s placed 5 released to counties 20 inmate past positive screenings 4 inmate converters-with no sx/negative CXR

20 LTBI treatment 13 inmates were started & completed LTBI treatment as a result of this contact investigation 4 did not complete treatment for various reasons

21 Staff During this contact investigation, 140 staff were also tested/screened-0 converters This number includes staff in the following areas: custody, medical, mental health, teachers & transportation

22 Conclusion A contact investigation in a prison has advantages: A somewhat captive population An electronic data base to identify contacts The ability to mobilize a team to conduct an investigation Accessibility to implement treatment with in a timely manner

23 Conclusion (Continued) A contact investigation in a prison has barriers: Contacts living in congregate settings Movement of population Transfer to within the prison system-distances between facilities Transfers in/out to court Releases to the community

24 Conclusion (Continued) Involvement of multiple staff Attitude of inmates toward medical Attitude of staff toward additional testing Potential for contacts to be in any one of 61 correctional facilities

25 Thank You Thanks for all your help throughout the years with our TB contact investigations.