Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska

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Confidentiality CONTENTS Introduction ........................................... 14.2 Purpose.............................................................. 14.2 Policy ................................................................. 14.2 Health Insurance Portability and Accountability Act (HIPAA) ................. 14.3 Centers for Disease Control and Prevention guidance on HIPAA ............................................ 14.3 Alaska HIPAA policies ....................................... 14.3 National Guidelines .............................. 14.4 Resources and References ................. 14.5 A L A S K A T U B E R C U L O S I S P R O G R A M M A N U A L Confidentiality 1 4 . 1 R e v i s e d N o v e m b e r 2 0 1 2
Introduction Purpose Use this section to determine what information and which records should be treated with confidentiality; identify state policy for maintaining patient confidentiality; take measures to ensure TB patients’ confidentiality; and determine when it is permissible to share information for public health reasons. The protection of private patient information is commonly referred to as confidentiality. Confidentiality involves the protection of information revealed during patient–healthcare worker encounters, including all written or electronic records of these encounters. Confidentiality is an essential issue in many different aspects of tuberculosis (TB) control. Healthcare workers need to be aware of confidentiality issues that are relevant to patient–healthcare worker encounters, as well as to the collection, management, and sharing of information gathered on TB patients. 1 Policy The State of Alaska has adopted a Health Insurance Portability and Accountability Act (HIPAA) policy that conforms to the national act. Information regarding Alaska DHSS HIPAA may be found at http://www.hss.state.ak.us/dhcs/HIPAA/default.htm Healthcare workers should keep patient information in confidence and divulge it only with the permission of the patient, except as otherwise required by law. 2 For roles and responsibilities, refer to the “Roles, Responsibilities, and Contact Information” topic in the Introduction 1.18. State Laws and Regulations Alaska regulations pertaining to patient confidentiality may be found in the Statutes and Regulations section of the manual 19.1. A L A S K A T U B E R C U L O S I S P R O G R A M M A N U A L C o n f i d e n t i a l i t y 1 4 . 2 R e v i s e d 1 1 / 2 0 1 2
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Alaska Tuberculosis Program Manual
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Purpose............................
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Monthly assessment of adherence ...
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When to Expand a Contact Investigat
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Introduction CONTENTS About the Ala
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How to Use This Manual Portable Doc
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Printing To access the print dialog
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Abbreviations Refer to the list bel
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QFT QuantiFERON ® -TB test QFT-G Q
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Alaska Statutes and Regulations on
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National and State Program Objectiv
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Indicator 3 Thorough contact invest
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National Standards and Recommendati
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Roles and Responsibilities Contact
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Local Public Health Agencies Table
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Resources and References Resources
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Introduction Purpose Use this secti
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Contact investigation: Collecting,
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Reporting Tuberculosis Detecting an
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Prompt reporting (prior to culture
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Use the Infectious Disease Report F
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Data Collection Forms The following
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Genotyping Genotyping is a useful t
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References 1 ATS, CDC, IDSA. Contro
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child or a person acting on behalf
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When to Conduct Targeted Testing Al
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Alaska Program Standards for Health
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B Notifications CONTENTS Introducti
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Table 1: NUMBERS OF FOREIGN-BORN PE
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chest radiograph and if sputum AFB
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Follow-up of B1 and B2 Tuberculosis
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Evaluation of B1, B2, and B Tubercu
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Treatment Prescribe medications as
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12 Centers for Disease Control and
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Tuberculosis Classification System
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Table 2: PERSONS AT HIGH RISK FOR T
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Table 3: WHEN TO SUSPECT PULMONARY
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Diagnosis of Tuberculosis Disease T
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1. Exposure to Infectious TB: Ask p
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Physical Examination A physical exa
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For more information on chest radio
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Laboratories should report positive
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Guidelines for preventing the trans
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50 CDC. National plan for reliable
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Introduction Purpose The overall go
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Basic Treatment Principles Follow t
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Treatment Regimens and Dosages Use
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Table 3: FOUR TREATMENT REGIMENS FO
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† 4 Table 4: DOSES*OF FIRST-LINE
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Figure 1:TREATMENT ALGORITHM FOR DR
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a. In remote locations in Alaska, m
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Antituberculosis Drug Rifampin (RIF
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Antituberculosis Drug Rifapentine (
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Reporting Reactions The table below
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Response to Treatment For consultat
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Figure 2: MANAGEMENT OF TREATMENT I
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Post-Treatment Evaluation Routine f
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Treatment in Special Situations Tre
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Resources For consultation regardin
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with an increase in overall complet
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Liver Disease Management of TB in p
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After the initial phase (first two
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Extrapulmonary Tuberculosis The bas
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Diagnosis of Latent Tuberculosis In
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Forms All required and recommended
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High-Risk Groups Certain factors id
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Diagnosis of Latent Tuberculosis In
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continually exposed to populations
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Administration of the Tuberculin Sk
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See “Two-Step Tuberculin Skin Tes
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See “Live-Virus Vaccines” under
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For more information on IGRAs and t
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Table 5: TARGETED TESTING FOR LATEN
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Treatment of Latent Tuberculosis In
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Policy Detailed information on the
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Window period prophylaxis is treatm
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Regimens Identify an appropriate re
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Dosages Once the appropriate regime
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Side Effects and Adverse Reactions
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If a patient reports to a healthcar
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Antituberculosis Drug Rifampin (RIF
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DOT is strongly encouraged for thos
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Table 7 describes the duration of t
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Alcoholism Alcohol-Related Treatmen
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Medication Administration and Pharm
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National Tuberculosis Controllers A
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24 CDC . “Recommendations for Use
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Diagnosis and Treatment of Latent T
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All children suspected or diagnosed
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Latent Tuberculosis Infection (LTBI
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History of BCG vaccination is not a
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Because of their higher specificity
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Table 3: COUNTRIES AND AREAS WITH A
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Treatment of Latent TB Infection (L
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For consultation regarding the trea
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Monitoring DOT is mandatory for INH
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For young infants, some experts rec
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TABLE 8: SIGNS AND SYMPTOMS OF PULM
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Treatment of Tuberculosis Basic pri
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Regime n 1 2 3 ❺ Table 10: FOUR T
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† 35 Table 11: DOSES*OF FIRST-LIN
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Monitoring Response to Treatment Ch
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Child Care and Schools: Children wi
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Other TB medications are not commer
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10 Centers for Disease Control and
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Case Management CONTENTS Introducti
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patient-centered approach to case m
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Alaska TB Program: Timeline for the
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For assistance with language issues
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Ascertain the extent of TB illness
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medical/health problem. The date of
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necessary to teach people how to ta
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Treatment Plan Components Recommend
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Implementation Activities To begin
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o Indicate the number of doses prov
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Review the status of the contact in
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For more information, see the “Di
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importance of continued treatment a
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5. Review information with the prov
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Completion of Therapy The case mana
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Case Closures Other than Completion
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Conduct a case management meeting o
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Biweekly (BIW) doses of TB medicati
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Use DOT with other measures such as
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It is important not to send a mixed
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Medical Orders Progressive Interven
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CDC. Module 9: “Patient Adherence
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36 New Jersey Medical School Nation
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75 CDC. Module 9: patient adherence
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Introduction Purpose A contact inve
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For roles and responsibilities, ref
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Decision to Initiate a Contact Inve
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chest radiographic findings that ar
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In general, a contact investigation
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Time Frames for Contact Investigati
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Circumstances unique to Alaska may
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Circumstances unique to Alaska may
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Activity Purpose Maximum Time Inter
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Infectious Period Determine the inf
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In general, for the purposes of con
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General Guidelines for Interviewing
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Healthcare workers should remember
Page 293 and 294: Index Patient with Positive Acid-Fa
Page 295 and 296: Index Patient with Negative Acid-Fa
Page 297 and 298: Contact Evaluation, Treatment, and
Page 299 and 300: Definition of abbreviations: HIV =
Page 301 and 302: Note: An IGRA may be used in place
Page 303 and 304: When to Expand a Contact Investigat
Page 305 and 306: Figure 7: EVALUATION, TREATMENT, AN
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Page 309 and 310: Definitions of abbreviations: AIDS
Page 311 and 312: elease assay; LTBI = latent tubercu
Page 313 and 314: officials to distinguish between di
Page 315 and 316: References 1 ATS, CDC, IDSA. Contro
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Page 319 and 320: Introduction Purpose Use this secti
Page 321 and 322: Available Laboratory Tests Table 2:
Page 323 and 324: Table 3: PCR Testing Algorithm and
Page 325 and 326: Table 4: SPECIMEN COLLECTION METHOD
Page 327 and 328: 5. If possible, send the specimen o
Page 329 and 330: Specimen Shipment There are three m
Page 331 and 332: Resources and References Resources
Page 333 and 334: Patient Education CONTENTS Introduc
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Page 337 and 338: Education Topics During the initial
Page 339 and 340: 10. Explain the signs and symptoms
Page 341 and 342: Patient Education Materials Get th
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Page 347 and 348: National Guidelines The following g
Page 349 and 350: Transfer Notifications CONTENTS Int
Page 351 and 352: For roles and responsibilities, ref
Page 353 and 354: Follow-Up Type When to Initiate Not
Page 355 and 356: Action Transfers Within Alaska Tran
Page 357 and 358: Provide the patient with a. A copy
Page 359 and 360: References 1 CDC. International not
Page 361 and 362: Infection Control CONTENTS Introduc
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Page 365 and 366: Administrative Activities 13 Key ac
Page 367 and 368: Personal Respiratory Protection Alt
Page 369 and 370: For regulations in your area, refer
Page 371 and 372: Employee Health All employees, phys
Page 373 and 374: Figure 1: TWO STEP TESTING AND FOLL
Page 375 and 376: Isolation To reduce disease transmi
Page 377 and 378: Table 4: CRITERIA FOR PATIENTS TO B
Page 379 and 380: When to Initiate Airborne Infection
Page 381 and 382: Confirmed Tuberculosis Disease A pa
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Page 385 and 386: Environmental Controls in the Patie
Page 387 and 388: Return to Work, School, or Other So
Page 389 and 390: Tuberculosis Infection Control in P
Page 391 and 392: Transportation Vehicles To prevent
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Forms: Alaska State Public Health L
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ALASKA STATE PUBLIC HEALTH LABORATO
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Anchorage Alaska State Public Healt
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INDEX CASE INFORMATION Name: DOB: /
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CONTACT Name: Tuberculosis Contact
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Directly Observed Therapy (DOT) Cal
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B. Documents patient care activitie
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Alaska TB Program Section of Epidem
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Treatment Summary for Active TB Nam
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Interjurisdictional Tuberculosis No
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Latent Tuberculosis Infection (LTBI
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Alaska Tuberculosis Program 9210 Va
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Instructions for Collecting Sputum
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TB Case Management Information Requ
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Table 1: First-line anti-tuberculos
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Return the fax to the Drug Room (90
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Stock Orders: A small supply of
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TB/LTBI Medication Return Form Reas
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TB/LTBI Stock Medication Request FA
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TB Medication Dose Monitoring Regim
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TB Medication Dose Monitoring Regim
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ALASKA DEPARTMENT OF HEALTH AND SOC
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Tuberculosis Discharge Planning Che
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PART 2: 8. Have you ever been told
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Tuberculosis Treatment Contract Dep
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Statutes and Regulations Contents I
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Regulations Infection Control 7 AAC
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place of work is remote from patien
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(2) the child or a person acting on
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Glossary acid-fast bacilli (AFB): M
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eaction size on a later test, which
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disseminated TB: See miliary TB. dr
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immunocompromised and immunosuppres
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include medical history and TB symp
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thousands to millions of copies of
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secondary (TB) case: A new case of
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eproducing TB organisms from respir
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Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska

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