Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska

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Regulations Infection Control 7 AAC 12.566. Infection control (a) A home health agency shall develop and implement written policies and procedures applicable to all agency staff that (1) minimize the risk of transmitting infection in all patient care or services; and (2) provide for the safe handling and disposal of biohazardous and infectious materials. (b) At least every two years, a home health agency shall verify that its employees, contractors, and volunteers who provide patient care receive training on universal precautions and the prevention, transmission, and treatment of (1) human immunodeficiency virus (HIV); (2) acquired immunodeficiency virus (AIDS); (3) hepatitis; and (4) tuberculosis. History: Eff. 9/6/96, Register 139 Authority: AS 18.05.040 Employee Health Programs 7 AAC 12.571. Employee health program (a) Except as provided in (b) - (e) of this section, a home health agency shall have an employee health program that requires each employee to be tested for pulmonary tuberculosis within the first two weeks of initial employment and annually thereafter. The home health agency shall require contractors performing patient care or services for the agency to have similar standards in place. (b) An employee who has never had a positive tuberculin skin test result must have a tuberculin Mantoux skin test. A further annual tuberculin testing is not necessary if the (1) test is negative; (2) employee is never required to be in a room where a patient or resident might enter; and 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 STATUTES AND REGULAT IONS 19.3 Revised November 2012
(3) employee does not handle clinical specimens from a patient or other material from a patient's room. (c) An employee who has a positive tuberculin skin test result, or previously had a positive tuberculin skin test result, must have a health evaluation to determine if tuberculosis disease is present. If the presence of tuberculin disease is confirmed, the employee shall be removed from direct contact with patients until the employee has received written verification from a physician that the employee is determined to be noncontagious. (d) If the employee has previously received appropriate antituberculosis chemotherapy and has no symptoms suggesting that tuberculosis is present, the employee need not have further annual tuberculosis evaluation. (e) A home health agency that provides care to pregnant women shall document that each employee who provides direct patient care has been immunized against rubella by having on file (1) a valid immunization certificate signed by a physician or registered nurse listing the date of rubella vaccination; (2) a copy of a record from a clinic or health center showing the date of rubella vaccination; or (3) the result of a serologic test showing the employee is immune. History: Eff. 9/6/96, Register 139 Authority: AS 18.05.040 7 AAC 12.650. Employee health program Note: the term “facility” is defined in 7 AAC 12.990 to mean a general acute care hospital, specialized hospital, nursing home, intermediate care facility for the mentally retarded, ambulatory surgical center, birth center, mental health center, home health agency, rural primary care hospital, and critical access hospital. (a) Each facility must have an employee health program that (1) requires each employee to be evaluated within the first two weeks of employment and, except as provided otherwise in this paragraph, annually after that, to detect active cases of pulmonary tuberculosis, as follows: (A) an employee who has never had a positive tuberculin skin test result shall obtain a tuberculin Mantoux skin test; if the tuberculin skin test result is negative, the employee does not need to have further annual tuberculosis evaluation under this paragraph if the employee's duties never require him or her to be in a room where patients or residents might enter, and if the employee does not handle clinical specimens or other material from patients or from their rooms; an example of such an employee is an administrative person or research worker whose 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 STATUTES AND REGULAT IONS 19.4 Revised November 2012
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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
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Index Patient with Positive Acid-Fa
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Index Patient with Negative Acid-Fa
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Contact Evaluation, Treatment, and
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Definition of abbreviations: HIV =
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Note: An IGRA may be used in place
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When to Expand a Contact Investigat
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Figure 7: EVALUATION, TREATMENT, AN
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CDC’s “Framework of Program Eva
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Definitions of abbreviations: AIDS
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elease assay; LTBI = latent tubercu
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officials to distinguish between di
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References 1 ATS, CDC, IDSA. Contro
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44 CDC, NTCA. Guidelines for the in
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Available Laboratory Tests Table 2:
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Table 3: PCR Testing Algorithm and
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Table 4: SPECIMEN COLLECTION METHOD
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5. If possible, send the specimen o
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Specimen Shipment There are three m
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Patient Education CONTENTS Introduc
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treatment, common side-effects of m
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Education Topics During the initial
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10. Explain the signs and symptoms
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Patient Education Materials Get th
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References 1 CDC. Module 4: treatme
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National Guidelines The following g
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Transfer Notifications CONTENTS Int
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For roles and responsibilities, ref
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Follow-Up Type When to Initiate Not
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Action Transfers Within Alaska Tran
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Provide the patient with a. A copy
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References 1 CDC. International not
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Infection Control CONTENTS Introduc
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of TB infection control principles
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Administrative Activities 13 Key ac
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Personal Respiratory Protection Alt
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For regulations in your area, refer
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Employee Health All employees, phys
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Figure 1: TWO STEP TESTING AND FOLL
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Isolation To reduce disease transmi
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Table 4: CRITERIA FOR PATIENTS TO B
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When to Initiate Airborne Infection
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Confirmed Tuberculosis Disease A pa
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Multidrug-Resistant Tuberculosis Di
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Environmental Controls in the Patie
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Return to Work, School, or Other So
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Tuberculosis Infection Control in P
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Transportation Vehicles To prevent
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7 CDC. Guidelines for preventing th
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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: /
Page 403 and 404: CONTACT Name: Tuberculosis Contact
Page 405 and 406: Directly Observed Therapy (DOT) Cal
Page 407 and 408: B. Documents patient care activitie
Page 409 and 410: Alaska TB Program Section of Epidem
Page 411 and 412: Treatment Summary for Active TB Nam
Page 413 and 414: Interjurisdictional Tuberculosis No
Page 415 and 416: ! !"#$%&'%()*(+#(,"-./0'1$%+'.,)()/
Page 417 and 418: ! B!9:(78;7)3702D!! ! 3"#$%&%''98#5
Page 419 and 420: ! ?"#51)09/02!H0/.!9:(78;7)37028!/'
Page 421 and 422: Latent Tuberculosis Infection (LTBI
Page 423 and 424: Alaska Tuberculosis Program 9210 Va
Page 425 and 426: Instructions for Collecting Sputum
Page 427 and 428: TB Case Management Information Requ
Page 429 and 430: Table 1: First-line anti-tuberculos
Page 431 and 432: Return the fax to the Drug Room (90
Page 433 and 434: Stock Orders: A small supply of
Page 435 and 436: TB/LTBI Medication Return Form Reas
Page 437 and 438: TB/LTBI Stock Medication Request FA
Page 439 and 440: TB Medication Dose Monitoring Regim
Page 441 and 442: TB Medication Dose Monitoring Regim
Page 443 and 444: ALASKA DEPARTMENT OF HEALTH AND SOC
Page 445: Tuberculosis Discharge Planning Che
Page 448 and 449: PART 2: 8. Have you ever been told
Page 450 and 451: Tuberculosis Treatment Contract Dep
Page 452 and 453: Statutes and Regulations Contents I
Page 456 and 457: place of work is remote from patien
Page 458 and 459: (2) the child or a person acting on
Page 460 and 461: Glossary acid-fast bacilli (AFB): M
Page 462 and 463: eaction size on a later test, which
Page 464 and 465: disseminated TB: See miliary TB. dr
Page 466 and 467: immunocompromised and immunosuppres
Page 468 and 469: include medical history and TB symp
Page 470 and 471: thousands to millions of copies of
Page 472 and 473: secondary (TB) case: A new case of
Page 474: eproducing TB organisms from respir
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Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska

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