Prevention and Control of Tuberculosis in Correctional and Detention Facilities: Recommendations from CDC

Endorsed by the Advisory Council for the Elimination of Tuberculosis, the National Commission on Correctional Health Care, and the American Correctional Association

Disclosures

Morbidity and Mortality Weekly Report. 2006;55(27):1-44. 

In This Article

Tuberculosis Training and Education of Correctional Workers and Inmates

TB training and education of correctional workers and other persons associated with any correctional facility (e.g., volunteers and inmates) can help lower the risk for TB transmission and disease. To ensure the effectiveness of such training and education, multiple factors should be considered. First, correctional facilities and local or state health departments should collaborate when providing TB training and education to correctional workers; specifically, facilities should routinely work with health department staff to provide them with corrections-specific training. Second, routine TB education should be provided for all persons who spend significant time in the facility, and additional training should be given to any employee who will interact with persons at risk for TB. The ideal amount of training time and information varies by the local risk for TB transmission and by the job descriptions and characteristics of those needing training. Finally, TB training and education efforts and other TB-related events should be documented to ensure that these programs can be evaluated and updated.

Correctional workers, volunteers, inmates, and other persons spending significant time in correctional facilities should receive training and education regarding M. tuberculosis as part of in-facility, preservice training or orientation. Training should be provided at least annually thereafter.

In-facility training and education efforts can build on existing sources of TB-related preservice education and training. Regional and national professional associations frequently provide ongoing education regarding TB and infection control, and national correctional health-care conferences and courses for medical professionals working in correctional facilities regularly include TB in their curricula.

TB-associated training should be designed to meet the needs of correctional workers with diverse job descriptions. In multiple facilities and for multiple categories of correctional workers, appropriate TB training might be accomplished through incorporation of the topic into other annual employee trainings (e.g., bloodborne pathogen training); more extensive or topic-specific training should be developed for persons who are specifically involved in TB control. Facilities that use inmates to provide peer-to-peer TB-education programs should provide similarly tailored training to any participating inmates. Facilities located in areas with a high TB prevalence or whose inmates have lived in such areas might need to increase the time and resources dedicated to TB training.

The correctional facility health services director or designee (i.e., the staff member responsible for a facility's TB control program) should collaborate with the local public health department to establish TB education and training activities. In addition, these staff members routinely should evaluate and update the facility's TB training and education program in collaboration with the public health sector. External changes in the prevalence of TB in the community, changes in state or local public health policies, or changes in national TB control guidelines might necessitate the conduct of regular educational updates for staff.

Each facility should maintain training records to monitor correctional worker training and education. Records of TB-related adverse events (e.g., documented in-facility transmission) also should be monitored as a means of evaluating training and education outcomes. The circumstances of adverse events should be investigated, and the possibility of enhanced or altered training should be considered as an appropriate intervention.

Although the level and detail of any employee's initial TB training and education session will vary according to staff members' job responsibilities, the following components should be included for all correctional workers, regardless of job function:

  • communication regarding the basic concepts of M. tuberculosis transmission, signs, symptoms, diagnosis (including the difference between LTBI and TB disease), and prevention;

  • provision of basic information regarding the importance of following up on inmates or correctional workers demonstrating signs or symptoms of TB disease;

  • need for initiation of airborne precautions of inmates with suspected or confirmed TB disease;

  • review of the policies and indications for discontinuing AII precautions;

  • discussion of basic principles of treatment for TB disease and LTBI; and

  • discussion regarding TB disease in immunocompromised persons.§§

Correctional workers in facilities equipped with AII rooms also should be provided clear guidelines regarding the identification and containment of persons with TB disease. Education efforts for these staff members should include 1) discussion of the use of administrative and engineering controls and personal protective equipment and 2) a respiratory protection program (including annual training) as mandated by OSHA (Standard 29 CFR OSHA/DOL[87]).

Correctional workers in facilities with a high risk for TB transmission should receive enhanced and more frequent training and education concerning

  • the signs and symptoms of TB disease,

  • transmission of TB disease, and

  • TB infection-control policies (including instruction on and location of the facility's written infection-control policies and procedures, exposure control plan, and respiratory protection program).

If a contact investigation is being conducted because of suspected or confirmed infectious TB, the health department or designated health provider should educate facility correctional workers in all aspects of the investigation. Education should include information concerning

  • contact investigation guidelines,[165]

  • TB transmission,

  • the method used to determine a contact's risk for infection and prioritization for evaluation and treatment,

  • the noninfectiousness of inmates and correctional workers with LTBI,

  • the noninfectiousness of persons with TB disease who have responded to therapy and have submitted three AFB negative sputum-smear results, and

  • patient confidentiality issues.

Facility staff members who are responsible for TB-control activities should stay informed regarding current TB trends and treatment options. Conference attendance, participation in professional programs, and other off-site training are effective supplemental training strategies for correctional worker trainers and facility medical and infection-control staff.

State and local health department staff providing consultation or direct services to a correctional facility (including those who act as liaisons) should receive training and education regarding the unique aspects of health care and TB control in the correctional facility setting. Correctional facility administrators, contracted correctional facility health-care professionals, and health department staff should collaborate to develop an appropriate training program. The use of self-study and other educational materials should be encouraged as a supplement to training. Certain TB training resources also can be accessed on the Internet (Appendix A). Education and training of health department staff should cover (but not be limited to) the following topics:

  • TB-related roles of correctional facility and health department staff;

  • methods of effectively collaborating with correctional facilities;

  • differences between and among jails, prisons, and other forms of detention facilities;

  • correctional culture and the importance of respecting the mission and purpose (i.e., custody) of correctional facilities and correctional workers;

  • the health department's role in the discharge of inmates (see Discharge Planning); and

  • the effect of the custody and movement of foreign detainees on local facilities.

Inmates should receive education from facility health-care professionals or other appropriately trained workers managing the screening or treatment process. Education and training should be appropriate in terms of the education level and language of the trainees. The following components should be incorporated into inmate training and education programs:

  • general TB information (provided either at the time of admission or when being screened for TB);

  • the meaning of a positive TST or QFT-G result and treatment options for LTBI;

  • comprehensive TB education, including the infectiousness of and treatment for inmates being confined with suspected or confirmed TB disease; and

  • the importance of completing treatment for inmates with LTBI or TB disease.

§§ Because being immunocompromised (having pathologic or iatrogenic immune suppression, e.g., HIV infection or chemotherapy) is a risk factor for TB disease, correctional workers should be educated on the relation between TB and medical conditions associated with being immunocompromised. Correctional workers should be encouraged to discuss known or possible immunocompromising conditions with their private physicians or health-care professionals.

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