5/8/2017 1 Contact Investigation Overview Jan Dougan, RN May 4, 2017 Essential Skills for the TB Nurse Case Manager Little Rock, AR May 3‐4, 2017 Jan Dougan, RN has the following disclosures to make: No conflict of interests No relevant financial relationships with any commercial companies pertaining to this educational activity
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5/8/2017
1
Contact Investigation Overview
Jan Dougan, RNMay 4, 2017
Essential Skills for the TB Nurse Case Manager Little Rock, ARMay 3‐4, 2017
JanDougan,RN has the followingdisclosures to make:
No conflict of interests
No relevant financial relationships with any commercial companies pertaining to this educational activity
5/8/2017
2
EXCELLENCE EXPERTISE INNOVATION
OverviewofContactInvestigationGuidelines
JanDougan,RNTBCMADH
Contact Investigation OverviewMay 3‐4, 2017Little Rock, AR
• Health departments are responsible for ensuring and conducting contact investigations.
– Non jurisdiction setting• Military base
• Diplomatic missions
• Reservations for American Indian/Alaska Native Tribes
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• Decisions to Initiate a CI• Investigating the index patient• Assigning priorities• Diagnostic and PH Evaluation of
Contacts• Treatment of Contacts• When to expand a CI• Confidentiality and Consent in a CI• Data Management • Staffing and Training• Other considerations
– Media– Special circumstances– Source Case Investigation
•Are program objectives being met for High/Medium contacts?
•Is the positivity rate 10% or twice the number expected in a SIMILAR population?
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NationalTBProgramObjectivesAugust2015
Objectives on Contact Investigations Targets
Contact Elicitation For TB patients with positive AFB sputum‐smear results, increase the proportion who have contacts
elicited.
100%
Examination For contacts to sputum AFB smear‐positive TB cases, increase the proportion who are examined for
infection and disease.
93%
Treatment Initiation
For contacts to sputum AFB smear‐positive TB cases diagnosed with latent TB infection, increase the
proportion who start treatment.
91%
Treatment Completion
For contacts to sputum AFB smear‐positive TB cases who have started treatment for latent TB infection, increase the proportion who complete treatment.
81%
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention; Division of Tuberculosis Eliminationhttp://www.cdc.gov/tb/programs/evaluation/indicators/default.htm
CalculatingtheInfectionRate
The infection rate is defined as: The percentage of contacts with SIMILAR exposure who have a newly identified positive skin test (5mm or larger) OR IGRA.
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Herearethesteps…
Determine the total number of contacts evaluated. Do not include previous positive TST or refusals
Determine the infection rate.
Divide the number of contacts with a new +TST documented (numerator) by total number of contacts evaluated (denominator)
Multiply by 100 the resulting percentage is the infection rate.
Example
10 contacts were identified for a TB case1 contact had a previous + TST6 were positive 3 were negative
10 ID – 1 Previous +
Of 9 tested 6 were +
X 1006 contacts +TST
9 contacts tested= 67%
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So,NowLetsTryResult Contact
10mm Johnny Depp
Previous + Arnold Schwarzenegger
15mm Harrison Ford
00mm Emma Watson
00mm Leonardo DiCaprio
Refused Tom Cruz
20mm Brad Pitt
Result Contact
00mm Kate Winslet
00mm Tom Hanks
00mm Matt Damon
8mm Cameron Diaz
00mm Anne Hathaway
Previous + Jessica Alba
4mm Jimmy Fallon
Total Contacts id’d
Previous +
Refused
Total screened
Total positive
14
2
4
11
1
DotheMath
Total Contacts id’d
Previous +
Refused
Total screened
Total positive
14
2
4
11
1
14 ID – 3 ( 1PP&1 R)
Of 11 tested 4 were +
X 1004 contacts +TST
11 contacts tested= 36%
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ConfidentialityandConsentinaCI
• Essential to maintain credibility
• It’s the law
• Make it a partnership
• Role play
• Make it clear
• Management of care and follow up for contacts
• Epidemiologic analysis of an investigation
• Program evaluation using performance indicators.
– Cohort review
DataManagement
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• Should be conducted by a TRAINED staff member
– What does that mean?
• No guidelines on training requirements.
• What are program guidelines for training
StaffingandTraining
PutThisinPerspective
• 2015 Arkansas Board of Cosmetology License Requirements