Louisville Medicine Volume 67, Issue 2 | Page 12

PUBLIC HEALTH (continued from page 9) · https://chfs.ky.gov/agencies/dph/dehp/idb/Pages/tuberculosis.aspx For clinical consultation, please contact me at (502) 523-6740 or Aimee Mihalyov, APRN at (502) 574-6716. In our region, the Southeast National Tuberculosis Center (SNTC) has national con- sultants available at 1-800-4TB-INFO. · KRS 215.531 Drug susceptibility tests on initial isolates from patients with active tuberculosis. · KRS 215.550 Responsibilities of persons diagnosed with active tu- berculosis. · KRS 215.560 Affidavit of failure to comply -- Administrative and judicial action. · KRS 215.570 Violation of court order -- Penalties. · KRS 215.580 Legal representation of local health department in en- forcement. · KRS 215.590 Responsibility to report active tuberculosis cases and results of drug susceptibility tests on tubercle bacilli. · KRS 215.600 Title of law. · 902 KAR 2:020 Disease surveillance · McWilliams T, Wells AU, Harrison AC, et al. Induced sputum and bronchos- copy in the diagnosis of pulmonary tuberculosis. Thorax. 2002;57:1010-1014. 902 KAR 2:040 Surveillance and screening of carriers and selected groups · 902 KAR 2:090 Tuberculosis detection, prevention, and control George PM, Mehta M, Dhariwal J, et al. P55 Post-bronchoscopy sputum: increasing the diagnostic yield in smear negative pulmonary tuberculosis. Thorax 2010;65:A100-A101 · 902 KAR 20:016 Hospitals; operations and services · 902 KAR 20:200 Tuberculosis testing in long-term care facilities · 902 KAR 20:205 TB Testing of Healthcare Workers Thank you for your partnership and collaboration in helping to control TB in our region. Dr. Caloia is the Medical Director of the Louisville Metro Department of Public Health and Wellness. Notes 1. 2. 3. 4. 5. Centers for Disease Control and Prevention. Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005. MMWR 2005;54(No. RR-17). https://www.cdc.gov/mmwr/pdf/rr/ rr5417.pdf. National Tuberculosis Controllers Association and American Public Health Laboratories. Consensus statement on the use of Cepheid Xpert MTB/RIF assay in making decisions to discontinue airborne infection isolation in healthcare settings. 2016. Accessed 1/6/19 at: http://www.tbcontrollers.org/ docs/resources/NTCA_APHL_GeneXpert_Consensus_Statement_Final.pdf KDPH TB Control website and TB laws 6. Epid 200 disease reporting form: https://louisvilleky.gov/sites/default/files/ health_and_wellness/communicable_disease/epid_200_kentucky_report- able_disease_form.pdf 7. Current Center for Disease Control and Prevention TB Guidelines can be found at: https://www.cdc.gov/tb/publications/guidelines/default.htm GUIDELINES FOR TUBERCULOSIS: 1. Encourage providers to consider tuberculosis in their differential diagnosis. 2. Obtain sputum sampling with AFB smears and culture for TB prior to invasive testing that could potentially increase the risk for spread of TB by inducing cough or otherwise increasing aerosolization. If a patient is suspected of having tuberculosis, and sputum sampling is not possible in your setting, please contact LMPHW so we can quickly obtain patient samples in our office. 3. If TB is suspected, isolate the individual to protect your staff and other patients. 4. Obtain appropriate evaluation prior to starting patients on anti-tuberculosis medication. Never start a patient on monotherapy as resistance can easily develop to these medications. 5. Providers with limited experience in treating latent tuberculosis infection (LTBI), should refer individuals who test positive and who have not been previously treated to the LMPHW Regional TB Clinic or a qualified infec- tious disease specialist. 6. Please contact LMPHW upon first suspecting tuberculosis in a patient, and prior to hospital discharge to es- tablish a follow-up care plan. 7. Directly Observed Therapy (DOT). for tuberculosis antibacterial medications is the standard of care in the United States. Appropriate dosage regimen and documentation of these observed doses is required for all individuals being treated for tuberculosis. The LMPHW Regional TB Clinic has the resources to provide this standard of care. 10 LOUISVILLE MEDICINE