TB Nurse Case Management Norman, Oklahoma October 8-10, 2008

Transcription

1 TB Nurse Case Management Norman, Oklahoma October 8-10, 2008 Contact Investigation Techniques: Using Social Networking to Identify Contacts Diane Wermy, BA, BS Mary Spinner, RN, BSN October 9, 2008 CONTACT INVESTIGATION TECHNIQUES: USING SOCIAL NETWORKING TO IDENTIFY CONTACTS Diane Wermy, BA, BS, Disease Intervention Specialist Mary Spinner, RN, BSN, TB program Administrator Oklahoma City-County Health Dept., TB Control Center 1

2 Idioms of a Social Life in TB no man is an island Humans are social Do not get TB without sharing airspace with somebody Need to know the round the clock picture Persons may spend most of their time outside home/family environment Social Network Analysis Social Network linkage of persons and places where M. tuberculosis is spread via shared air space Social Network Analysis methodology of visualizing and quantitating the relative importance of members in a social network Social Network Analysis assumes there is some detectable patterning of the TB cases and their contacts in a community Information courtesy of CDC 2

3 Social Network Analysis Approach (1) Provides a systematic method to deal with data already gathered in routine contact investigations Analysis of the network can help identify important contacts (i.e., those most likely to be infected) Real-time monitoring of network growth may facilitate early detection of outbreaks Information courtesy of CDC Social Network Analysis Approach (2) May help programs focus control efforts May offer effective way to list contacts and assign priorities Has been tested retrospectively on TB outbreak and contact investigations Information courtesy of CDC 3

4 Process Tools organizational skills database weekly CI reviews interview proficiencies (competencies) work sheets human resources case management Family/Extended Family Other Than Close Close Work CASE Leisure/Social Recreational 4

5 CI TB SKIN TEST QUESTIONNAIRE/CONSENT FORM Name: Date of Birth CONTACT INFO WORKSHEET Phone Number: Social Security #: Contact name: Address: Street Apt.# City State Zip Code Today s date: Race: White Black Am.Indian Asian Sex: M F Hispanic Origin: Y N Name of case/suspect 1. Do you have a productive cough lasting more than 3 weeks? Yes No (As identified by contact) If Yes, Have you coughed up any blood? Yes No When was this person sick? 2. Have you ever had a TB skin test before? Yes No If Yes, Did you get a positive result? Yes No Case/suspect a resident of OK County yes no If Yes, Did you have an x-ray? Yes No If not, where does or did case/suspect live? Did you take TB medication? Yes No 3. In the pa st 3 months ha ve you experienced Yes No Weight loss? Night sweats? Fatigue? Type of contact: household (live with case) social work 4. Are you sick today? Yes No Describe: If Yes, Do you have a fever? Yes No Have you seen a doctor? Yes No What was the diagnosis? 5. Are you taking medication, including TB medication now? Yes No 6. Have you had a live immunization (measles, mumps, rubella, chicken pox, polio, yellow fever) in the past 6 weeks? Yes No 7. Were you born in the United States? Yes No What activity and how much time was spent with the case/suspect? If No, where 8. Do you know your HIV status? If yes, circle results: POS NEG Yes No 9. Are you diabetic? Yes No 10. Do you drink alcohol? (Or use other drugs?) Yes No 11. Are you a smoker? Yes No 12. Do you have a history of hypertension? Yes No Blood pressure today Blood pressure/smoking cessation information given? Yes No Please do not write below this line, it is for the CI and CM only I have read, or have had read to me the Questionnaire/Consent Form and fact sheets. By my signature, I give my permission for the administration of the TB Status of case/suspect: skintest, RPR and HIVlab testing to me or the above named person for whom I am authorized to make such decisions. I have been given the opportunity to ask question s and have them answered to my satisfaction. I also grant permission for entry o f my personal informatio n in to a Homel ess Manag ement Information System should it become necessary. Verified: yes no Clinical dx: smear pos cx pos I hereby au thorize the Oklahoma City County Health Department to release the ab ove Skin Test results to me. I understand that the law of the State of Oklaho ma states t he following: "The information authorized for release may include records which may indicate the presence o f a communicable or venereal disease which may include, but are not limited to, diseases such as hepatitis, syphilis, gonorrhea and the huma n immunodeficiency virus, Pulmonary X-pulmonary LPC also known as Acquired I mmune Deficiency Syndrome (AIDS)." In order to complete our contact investigation we may need to follow up with an additional skin test if this test is negative. In approximately 8-10 weeks we will contact you concerning the date, time, and place of the retest. Signature: Date: Wit ness: Date: Process cont. Data gathering interview case, contacts, other agencies, employers, coworkers, DOT providers, health care providers follow-up interviews genotype reports database 5

6 Process cont. Organization database names-formal & AKA location where exposure occurred activity length of time/frequency genotype Process cont. Analysis the pieces come together software to analyze data and make diagrams draw pictures, concentric circles 6

7 Visualization of the identified links among the first 35 tuberculosis patients during an outbreak investigation in southwest Oklahoma, Visualization of the first 35 tuberculosis (TB) patients and all contacts in need of clinical evaluation for TB and latent TB infection in southwest Oklahoma,

8 Process cont. Results Targeted resources Program planning Network development (DIS, corrections) TB Control TB Elimination Healthy communities CASE STUDY 5/31/2002 Initial Interview 27 yo WM Nub IDDM Usage of marijuana, speed, ETOH Construction worker Common-law spouse, son, stepdaughter Sputum AFB smear >10/hdf Bilateral cavitary disease Symptomatic ~ 2 months 8

9 CASE STUDY (cont.) 6/03/2002 Follow-up interview Couch homeless Carpools with co-workers Barbeques every Sunday Hangs out at Val s, Bear CASE STUDY (cont.) 6/10/ contacts tested 19 infected 13 month-old with disease 9

10 Infected Contacts by Age Group Family 1 Social 4 Work 1 Social yrs 5-14 yrs yrs yrs yrs >65 yrs Social 1 Case 27 yo Family 2 Social 4 Work 5 Family/Extended Family 10 contacts 10 neg Work 16 contacts Other Than Close Close CASE 1 neg 6 neg 36 neg Leisure/Recreational/Social 46 contacts 10

11 Family/Extended Family 10 contacts 6/10/ neg Work 16 contacts Other Than Close Close CASE 1 neg 6 neg 36 neg 4 neg Neighbors/Friends 3 neg Leisure/Recreational/Social 46 contacts Infected Contacts by Age Group Family 1 Social 4 Work 1 Work 1 Social 1 Work yrs yrs yrs yrs yrs >65 yrs Social 1 Case 27 yo Family 2 Social 4 Work 5 Social 2 Family 1 11

12 Family/Extended Family 10 contacts 8/28/ /14/2002 Other Than Close Close 1 neg Former co-worker Neighbors/Friends CASE Current Work 16 contacts Leisure/Recreational/Social 46 contacts Family/Extended Family 10 contacts 8/28/ /14/2002 Other Than Close Close 1 neg Former co-worker CASE BBQ Val s Current Work 16 contacts Neighbors/Friends 12

13 Moral of the Story Keep on Digging Observe and Listen Read Between the Lines Use Your Tools Listen to Your Inner Voice; Trust Your Gut What Goes Around, Comes Around TB 13