In this issue...
Reporting Issues from Hospitals
Mandate to Report Suspected/Confirmed Tuberculosis Disease
Responsibilities of the Local Health Department
Treatment Plans
Duty to Notify in Cases of Involuntary Isolation
Cultural Assistance for health care providers
The following is a reprint from an e-mail sent by Dr. Susan McLeod, District Director of the Thomas Jefferson Health District, Charlottesville, Virginia concerning reporting of TB cases and suspects from UVA Hospital. Dr. McLeod's e-mail points out some key facts that we should all keep in mind.
From Susan McLeod, M.D., District Director, Thomas Jefferson Health District
"Please forward this to your staff who handle reports of possible TB. I am sending it to all districts because UVA tells me they have dealt with HDs all across VA on possible TB cases. As stated to me by the Hospital Epidemiologist at UVA, health dept staff across the state are giving feedback to the infection control nurses that implies the HDs do not need the new report form or other documents on suspected TB cases. They have been told that "UVA has always done a good job of notification" so the case form developed as part of the law change last year is not needed from them because "many other hospitals don't report anyway." While I understand that HDs could be receiving some information that you might not need for a specific situation, please do not lead these infection control nurses to think they are wasting their time in the work they do to obtain and report on possible TB cases. Even if reports and information from UVA is not in the same format as from your ususal reporting sources, please try to express appreciation for the work done by the reporting staff. If you have specific feedback on an interaction you have had with UVA on a TB suspect or case that might help us guide them on how to do a better job in working with you, please tell me or Linda Vasquez, TJHD Nurse Manager. Thanks!"
Mandate to Report Suspected/Confirmed Tuberculosis Disease
In 2001, the Virginia General Assembly enacted legislation that revised the Virginia TB Control laws. Among these revisions were changes to reporting requirements. These changes provide the statutory mandate that local health departments be notified of ALL TB cases and suspects by physicians, health care facilities, and laboratories operating within the Commonwealth. The statute also mandates the collection of additional TB-specific information, beyond that routinely collected for other communicable diseases. For additional details on the reporting process for TB, please see the Guidebook to the Virginia Tuberculosis Control Laws available online at: External website, Internal website
Required reporting either by physicians, health care facilities or directors of laboratories operating within Virginia include:
NameFormSubmit ToTime Frame |
Purpose |
Initial TB ReportEPI-1Local Health DirectorWithin 24 hours by the most rapid communication means possible |
Report new case when there are reasonable grounds to believe that a person has active TB disease (e.g. when treatment is initiated) |
Secondary TB Report2001A-TB-002Local Health DirectorWithin 1-2 weeks of the initial case report |
Additional TB-specific items required. Examples include: treatment information, radiology reports, bacteriology reports, susceptibility reports, etc. |
Subsequent Reports2001A-TB-003Local Health DirectorAs needed |
To be completed when: |
Responsibilities of the Local Health Department
In fulfilling their statutory obligation to control spread of communicable diseases such as TB, local health departments must insure that appropriate information is collected on all TB cases/suspects. In order to fulfill this obligation, localities must have established procedures to facilitate the collection of required information from providers, systems to verify that reporting has occurred as required and that the information is accurate, and a plan for addressing situations where providers, institutions, or laboratories have failed to report. Finally, localities must have procedures in place to ensure that patients with confirmed/suspected tuberculosis disease have access to treatment and required clinical follow-up care.
Current regulations governing reporting of communicable diseases require that health care providers, health care facilities, and laboratories, report to the jurisdiction in which they are located. In instances where the patient does not reside in the same locality as the treating physician or facility, local health districts must insure prompt transmittal of the report to the appropriate jurisdiction. From a customer-service standpoint it is inappropriate to decline to accept the information and refer the reporting individual to another jurisdiction. Many of our community partners are unfamiliar with the structure of our health department system. Graciously accepting the information and agreeing to notify the appropriate jurisdiction will facilitate communication and help strengthen our partnerships with those in the private sector.
In some instances the facility may report directly to the receiving jurisdiction as a matter of courtesy. As Dr. McLeod points out in her note, if there are issues with the reporting process or completeness of the report from a specific facility, the appropriate action is to address these with the home jurisdiction of the facility rather than potentially undermining the efforts of the home district to build relationships with their local facilities. While different districts may have different processes for implementing the reporting process, all districts are subject to the provisions of the statutes as passed by the General Assembly.
Care should be taken not to confuse the reporting process and forms with the requirement for treatment plans. In addition to strengthening the TB (surveillance) reporting requirements, the TB Control Act of 2001 mandated that physicians maintain a written treatment plan on all persons (cases and suspects) undergoing treatment for active tuberculosis disease as well as a written record of adherence to therapy. The rationale behind this requirement is to provide a mechanism by which providers may communicate with local health officers about TB patients in their communities. It would be impossible for a local health officer to assure that a patient with communicable tuberculosis is receiving appropriate therapy and therefore is not a threat to the public health if s/he is unaware of the treatment and follow-up being provided. In some instances the physician is required to submit this plan to the health department. In other instances, these records only need to be submitted upon request of the local health department. The Division of TB Control developed a template treatment plan form that can be used for this purpose. However, the treating physician may submit this information in any format he/she chooses as long as the information specified in the statute is included. Use of the treatment plan template form is optional, use of the required reporting forms is not.
Section 32.1-116.3 of the Code of Virginia requires "any person requesting or requiring any employee of a public safety agency as defined in subsection J of 32.1-45.2 to arrest, transfer, or otherwise exercise custodial supervision over an individual known to the requesting person to be infected with any communicable disease shall inform such public safety agency employee of a potential risk of exposure to a communicable disease."
Please keep this statute in mind for instances when it is necessary to call for emergency transportation to a medical facility or in emergency isolation proceedings. Local health districts should work with local emergency services to insure that staff are properly trained and fitted for appropriate personal respiratory infection masks in the event that emergency isolation procedures need to be undertaken.
Listed below is a website devoted to Cultural Orientation for refugees resettling in the United States.
http://www.culturalorientation.net/
Prior to arrival, refugees are processed by a number of governmental and non-governmental agencies. During this processing, most refugees will receive cultural orientation training. Additional orientation and training is provided by resettlement agencies and groups across the United States. The above website provides information on a number of items including resettlement programs in the U.S. and cultural profiles.