Substance abuse providers are obligated by Federal and State laws (and their own ethics) to provide or arrange for TB screening and followup for their patients, to report communicable diseases, including TB, to local or State public health officials, to protect the confidentiality of their patients, and to provide a safe workplace for their employees and others.
This TIP makes a number of recommendations that will help providers reconcile (and comply with) those potentially conflicting obligations.
Those recommendations are summarized below.
The alcohol and other drug (AOD) and public health fields should collaborate with each other to prevent the transmission of TB in the AOD setting.
Collaboration would benefit shared patients, the public at large, the public health field, and AOD treatment providers.
The Federal confidentiality laws do not prevent the two fields from collaborating with each other.
To promote a good working relationship, the AOD and public health fields should:
Use patient consent and qualified service organization agreements to share patient-identifying information
Develop cooperation agreements that describe the roles and responsibilities of each with respect to TB screening, treatment, and followup
Cross-train each other's workers
Develop mutually beneficial propaganda (e.g., brochures and posters)
AOD programs are required to provide or arrange for TB-related services for their patients.
Those services must include mechanisms for screening, evaluating, treating, and following up patients with active disease or patients in treatment.
In providing those services, AOD programs should:
Be sure to detect, isolate, and treat patients and applicants with active TB
Take care not to discriminate against those with TB who are not infectious and pose no threat of transmitting TB to others
Use intake questionnaires that focus on the signs and symptoms of TB and on past TB involvement including treatment, if any, and preventive therapy, if any
Provide purified protein derivative (PPD) skin testing for all high-risk applicants
Ensure that applicants and patients with positive PPDs receive proper medical evaluation
Report suspected and confirmed cases of active TB to local or State public health officials, as mandated by State law
Remove or isolate patients with active disease
Ensure that patients in need of TB treatment receive it
Use directly observed therapy to promote patient adherence to recommended treatment or preventive therapy regimens
Monitor patients in treatment or preventive therapy for adherence, efficacy of treatment, and side effects
Screen patients periodically for TB
Educate patients about the risk of TB in the facility, the signs and symptoms of TB, TB treatment, preventive therapy, and the side effects of TB medications
Keep careful records of PPDs, evaluations, x-rays, diagnoses, etc.
Collaborate with public health officials and others to ensure appropriate screening, evaluation, treatment, monitoring, and record keeping.
To promote a safe workplace, AOD providers should collaborate with public health officials and workplace safety specialists.
Providers must be sure to exclude from the workplace any patients and employees who have active TB disease.
In general, AOD providers should:
Develop a site-specific TB risk assessment
Develop a written TB-infection control policy based on that assessment
Employ a hierarchy of controls to prevent the spread of TB in the facility, placing particular emphasis on administrative controls
Screen new employees for TB
Counsel employees about the risk of TB at the facility
Arrange for annual or more frequent PPDs, depending on the risk of TB at the facility, for all employees
Analyze all PPD conversions
Try to determine the source or sources of TB exposures at the site, if any
Train employees regarding the facility's TB-infection control policy
Arrange to review safety practices at regular intervals or whenever there is reason to believe that TB may have been transmitted on the premises
Take care not to discriminate against employees with noninfectious TB
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