Public Health Interventions to Reduce TB Risk in Homeless Populations
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1 Public Health Interventions to Reduce TB Risk in Homeless Populations International Union Against TB and Lung Disease: Nursing Assembly Marcia Stone, Public Health Nurse Health Care for the Homeless Public Health Seattle & King County February 26, 2009
2 Acknowledgements Eyal Oren and Margaret Ragland epidemiologists TB Control Program, Public Health-Seattle and King County Health Care for the Homeless staff and community partners All the dedicated and conscientious staff of the many homeless service agencies in King County
3 TB Outbreak Among the Homeless in Seattle-King County Homeless cases
4 Homeless Cases by Year No. of Cases Year Not Homeless Homeless
5 Seattle & King County Homeless Outbreak Tracking 88 cases have been linked by genotype in KC 2002: 2 non-homeless individuals 2007: 5 non-homeless individuals Over 1500 contacts screened in relation to ANY case matching this strain since 2002 Estimated 500 contacts not found 187 contacts identified in 2008 (all homeless cases) 92 contacts screened in 2008
6 Homeless in Seattle (King County) Nearly 8500 people enduring homelessness Jan One Night Count Day programs, hygiene centers, recovery programs, shelters, transitional housing Large and small agencies Single adult, family, youth, gender specific Many funding sources and philosophies 32 programs receive funds from City of Seattle Several high risk programs NOT funded by City High staff turnover
7 Why such a large outbreak? Contribution of social conditions: Homelessness/marginally housed/poverty/substance abuse Crowded living conditions Multiple highly infectious patients resulted in intense exposure in multiple homeless facilities and shared motel rooms Mobility of population: Move frequently between different shelters, staying with friends and family, motels, multiple day programs Urban Indian population frequently visits friends and family back home in other counties and states
8 Response to Outbreak: The Partnership Approach Public Health the Focal Point WA DOH SBRI CDC + lab WA St lab Public Health s TB Control Program TB EXPERTISE Public Health s Health Care for the Homeless Network HOMELESS EXPERTISE & COMMUNITY RELATIONSHIPS - Street & Shelter Visibility Public Health s Jail Health Program Homeless Sites Shelters Day Centers Sobering Center SRO Housing Taverns, Campsites, etc. Health System Partners - Harborview Medical Center - Community Clinics
9 Public Health Interventions TB and Homelessness Coalition TB Guidelines for Homeless Service Agencies City funds tied to minimum health standards in shelters HCH TB prevention nurse for homeless service agencies Focus group of those affected TB satellite site DOPT for contacts Incentives bus tickets, assistance with housing and other social services; cash discontinued Discharge planner/housing specialist in TB Clinic Resources for shelters
10 Ongoing Community Partnership Created TB and Homelessness Coalition Convened by Public Health: Health Care for the Homeless and TB Control Program With American Lung Association of WA Participants Functions Homeless Agencies Establish TB Prevention and TB Control Program Control Guidelines Health Care for the Identify training and TA Homeless needs Substance Abuse Share info BOTH WAYS Programs Expand to other Housing Programs health topics as Health Clinics needed Local Government Staff
11 TB and Homelessness Coalition Meets 3 times per year Update on status of TB outbreak/cases Agency update on implementation of shelter guidelines and other changes Guidance for LTBI prevalence study among homeless Smoking and TB Other health topics bed bugs, pan flu prep Screened new video Opportunity for agencies to provide feedback to PH Discussion/clarification of TBCP role in testing shelter staff
12 Health Care for the Homeless TB Prevention Nurse Funded by City of Seattle Assure agencies meet minimum health standards for TB Technical assistance to homeless service agencies TB and Homelessness Coalition Advocacy: provide information on agencies, key informants, and intricacies, subtleties and predictable social patterns in homeless world TB liaison between agencies and TB Control Program
13 Minimum Health Standards for TB Prevention Implement TB Guidelines for Homeless Service Agencies TB policy Written and available to staff Annual risk assessment Annual staff training/client education Reasonable progress toward action plan and commitments Symptom screening for shelter guests TSTs not required to stay in shelters
14 TB Risk Assessment TB Prevention and Control Guidelines for Homeless Service Agencies in Seattle- King County Risk assessment: Checklist developed from TB Guidelines Educational tool CDC Guidelines for Health Care Settings Review populations served, services provided, TB policy, physical layout, ventilation, client records, bed maps, TB education for staff and clients
15 TB policy Staff training, including new staff Client education TB screening for staff Environmental measures Agency response to illness cough alert policy and masks employee illness isolation procedures
16 Changes? Bed maps Improvements in record keeping Refinements in client intake screening questions Annual staff screening Annual staff education Increased awareness of ventilation and maintenance Improvements in shelter ventilation Participation in TB Coalition
17 Focus Group Data TB clinic location a barrier Alternative screening sites needed Incentives important Find site in ride-free bus zone
18 TB Satellite Site Partnership: TB Control Program and large centrally located homeless service agency PHN 3 days a week Screening for high-risk contacts DOT, DOPT and case management Access to database for contact investigation Ride-free bus zone Opportunities for partnerships with downtown community clinics and service
19 Resources Tuberculosis Prevention and Control Guidelines for Homeless Service Agencies in Seattle-King County, Washington Sample policy Ideas for posters TB Fact Sheet for Staff
20 Resources Shelters and TB: What Staff Need to Know Second Edition: CD and Viewers Guide cfm TB in Homeless Shelters: Reducing the Risk through Ventilation, Filters, and UV oads/tbhomelessshelters.pdf
21 Resources Maine Tool Kit for Shelters 20kit.doc What Your Shelter Can Do to Prevent TB Assessing Your Shelter Guests Risk for TB Cough Alert Policy Think TB Materials Stop TB Poster Cover Your Cough Poster Resources
22 Resources National Health Care for the Homeless Council Advocacy, Research, Training, Clinical Resources, Respite, Consumers, Publications Healing Hands--HCH Clinicians' Newsletters Homelessness Resource Center, SAMHSA Seattle King County Coalition for the Homeless: One Night Count
23 Reference Outbreak of tuberculosis in a homeless population involving multiple sites of transmission. Lofy, McElroy, et al. Int J Tuberc Lung Dis 10(6):
24 Contact Information Marcia Stone, Public Health Nurse Health Care for the Homeless Public Health Seattle & King County
April King-Todd 2014 National TB Conference Atlanta, Georgia June 10, 2014
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