Contact Investigation Salina, Kansas

Transcription

1 Contact Investigation Salina, Kansas March 29-31, 2010 Prioritizing Contact Investigations: Using Resources Wisely Phil Griffin, BBA, CPM March 29, 2010 Prioritizing Cases Phil Griffin TB Controller Kansas Department of Health and Environment 1

2 Objectives Discuss ss the decisions to initiate a contact investigation. Identify the factors that make transmission of TB more likely. Initiating a Contact Investigation A contact t investigation should be considered if the index patient has confirmed or suspected pulmonary, laryngeal or pleural TB. An investigation is recommended if the sputum smear is positive. 2

3 Initiating a Contact Investigation Sputum smears are highly hl recommended d prior to starting therapy if at all possible. In the absence of sputum smears, smears from other methods (i.e. gastric aspirates or bronchoalveolar lavage) g) should be considered in the same manner as sputum smears. 3

4 Prioritization Factors Site of disease Sputum Smear results Nucleic acid assay results (other rapid) Chest X-Ray results Index patient contributing i factors Index patient environmental factors Resources Site of Disease Pl Pulmonary Laryngeal Pleural Extrapulmonary 4

5 Sputum Smear Results Smear Positive Smear Negative Non sputum smears Nucleic Acid Assay Results Positive Negative Other rapid methods 5

6 Chest X-Ray Results Normal Abnormal Index Patient Factors Age HIV Status Other Medical Conditions Symptoms 6

7 Index Patient Environmental Issues Family structure t Employment Housing Socialization Recreation Children, Elderly, Frail Resources Case management Contact investigators Fiscal constraints Seasonal implications Oh Other investigationsi i 7

8 So Who Goes First? Gth Gather data dt Evaluate Organize plan Act on plan Monitor and evaluate Priorities Confirmed smear positive pulmonary Smear negative abnormal CXR not consistent w/tb 8

9 They all qualify as high risk, top priority! Ask for Help Often times the greatest t challenges of a TB contact investigation are the result of failure to ask for help when it is needed. Even the Lone Ranger had Tonto by his side 9

10 Ask for Help Look elsewhere in the local l health department Disease Intervention Staff STD Staff Preparedness Staff Immunization Staff Administration Ask for Help State Assistance State Tuberculosis people are nice people, they enjoy helping others, they want to be your friend, part of their mission is to be there for you, asking them for help will make them happy people. You have not failed by asking for assistance. 10

11 Ask for Help Centers for Disease Control and dprevention Available with many resources at the request of the state. Technical assistance Epi-Aid Financial assistance Questions to ask How infectious is the case? How long has was the case likely infecting? What are the characteristics of the likely contacts? What additional information is needed? How complex is the investigation likely to be? 11

12 Questions to ask What resources will likely l be required? What resources do I have available? What resources could be reallocated? Who else could assist? Who do we need to inform? What are the likely obstacles? How do I encourage the team? Take Action Once the priorities iti have been set, move on, take action. Plans can change. Be flexible but not wishy washy. Be thorough and complete. 12

13 Summary In many cases, prioritizing multiple contact investigations at one time is not required. In most cases of medium and low incident states, multiple cases are not being diagnosed in the same area at the same time, however, having a plan and policies in place for how to address this challenge is critical and the one time that it is needed you will be happy you prepared for it. 13

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