Tuberculosis

Idaho
Department of
Correction

Standard
Operating
Procedure

Division of
Education
and
Treatment

Operational
Services
Control Number:
401.06.03.076
Version:
2.0
Page Number:
1 of 7
Adopted:
3-1-2001
Reviewed:
12-28-2008

Title:
Tuberculosis

This document was approved by Dr. Mary Perrien, chief of the Division of
Education and Treatment, on 12/28/08 (signature on file).
BOARD OF CORRECTION IDAPA RULE NUMBER 401
Medical Care
POLICY STATEMENT NUMBER 401
Hospitalization, Institutional Clinical Services, and Treatment
POLICY DOCUMENT NUMBER 401
Hospitalization, Institutional Clinical Services, and Treatment
DEFINITIONS
Standardized Definitions List
Contract Medical Provider: A private company under contract with the Department to
provide comprehensive medical, dental, and/or mental health services to the incarcerated
offender population. A contract medical provider may include private prison companies and
other entities under contract with the Department to operate the Idaho Correctional Center
(ICC) and other out-of-state facilities housing Department offenders.
Facility Health Authority: The contract medical provider employee who is primarily
responsible for overseeing the delivery of medical services in an Idaho Department of
Correction (IDOC) facility.
Facility Medical Director: The highest ranking physician in an Idaho Department of
Correction (IDOC) facility.
Health Authority: The Department employee who is primarily responsible for overseeing or
managing the Department’s medical and mental health services. The health authority is
commonly referred to as the health services director.
Medical Director: A physician either employed by the Idaho Department of Correction
(IDOC) or contracted through privatized services (i.e., the physician in charge if medical
services are privatized).
Qualified Health Professional: A physician, physician assistant, nurse practitioner, nurse,
dentist, mental health professional or others who -- by virtue of their education, credentials,
and experience -- are permitted by law (within the scope of their professional practice) to
evaluate and care for patients.
Control Number:
401.06.03.076
Version:
2.0
Title:
Tuberculosis
Page Number:
2 of 7

Reception/Diagnostic Unit (RDU): Initial housing for newly committed offenders--except
those under sentence of death--where orientation, screening, assessment, and classification
occur.
Tuberculosis (TB): An infectious disease caused by bacterium that most commonly affects
the lungs.
PURPOSE
The purpose of this standard operating procedure (SOP) is to establish procedures for a
program to identify, counsel, evaluate, and treat offenders who have latent tuberculosis
infection (LTB) and active tuberculosis (TB).
SCOPE
This SOP applies to all Idaho Department of Correction (IDOC) healthcare services staff,
offenders, contract medical providers and subcontractors.
RESPONSIBILITY
Health Authority
The health authority is responsible for:
• Monitoring and overseeing all aspects of healthcare services, and
• The implementation and continued practice of the provisions provided in this
SOP.
When healthcare services are privatized, he will also be responsible for:
• Reviewing and approving (prior to implementation) all applicable contract medical
provider policy, procedure, and forms; and
• Monitoring the contract medical provider’s performance, to include but not limited
to reviewing processes, procedures, forms, and protocols employed by the
contract medical provider to ensure compliance with all healthcare-related
requirements provided in respective contractual agreements, this SOP, and in
National Commission on Correctional Health Care (NCCHC) standard P-B-01,
Infection Control Program. (See section 10 of this SOP.)
Contract Medical Provider
When healthcare services are privatized, the contract medical provider is responsible
for:
• Implementing and practicing all provisions of this SOP, unless specifically
exempted by written contractual agreements;
• Ensuring that all aspects of this SOP and NCCHS standard P-B-01 are
addressed by applicable contract medical provider policy and procedure;
• Ensuring facility health authorities utilize all applicable contract medical provider
policy, procedure, forms, and educational information to fulfill all healthcare-
related requirements provided in this SOP, NCCHC standard P-B-01, or as
indicated in their respective contractual agreement(s);
Control Number:
401.06.03.076
Version:
2.0
Title:
Tuberculosis
Page Number:
3 of 7

• Ensuring all applicable contract medical provider policy, procedure, and forms
are submitted to the health authority for review and approval prior to
implementation; and
• Administering tests for TB to both offenders and IDOC staff who work with
offenders.
Note: Nothing in this SOP shall be construed to relieve the contract medical provider(s)
of any obligation and/or responsibility stipulated in respective contractual agreements.
Facility Medical Director
The facility medical director and facility health authority (or designees) will be jointly
responsible for reporting cases of TB.
Facility Health Authority
The facility health authority will be responsible for:
• Ensuring the presence of an adequate number of appropriately trained staff and
materials are available to meet the requirements of this SOP, and
• Establishing and monitoring applicable contract medical provider policy and
procedure to ensure that all elements of this SOP and NCCHC standard P-B-01
are accomplished as required.
In addition, to the above responsibilities, the facility health authority and the facility
medical director (or designee) will be jointly responsible for reporting cases of TB.
Qualified Health Professional
The qualified health professional will be responsible for:
• Providing sufficient explanation and information to the offender to allow the
offender to understand the symptoms, screening process, and treatments
available for TB; and
• Documenting all clinical contacts in the offender’s healthcare record.
Table of Contents
General Requirements ......................................................................................................... 4
1. Transmission of Tuberculosis ......................................................................................... 4
2. Screening, Testing, and Treating Offenders for TB ......................................................... 4
Screening ................................................................................................................. 4
Treatment of LTBI or Active TB................................................................................. 5
3. Testing IDOC Employees for TB ..................................................................................... 5
4. Reporting Suspected or Active TB .................................................................................. 6
5. Transport of Offenders with Active TB ............................................................................ 6
6. Medical Isolation of TB Patients...................................................................................... 6
Respiratory Isolation ................................................................................................. 6
7. Food Service for Medically Isolated TB Patients ............................................................. 7
Control Number:
401.06.03.076
Version:
2.0
Title:
Tuberculosis
Page Number:
4 of 7

8. Laundry Control for Medically Isolated TB Patients......................................................... 7
9. Educating Offenders and IDOC Employees on Containing TB ....................................... 7
10. Compliance .................................................................................................................... 7
References ........................................................................................................................... 7
GENERAL REQUIREMENTS
1. Transmission of Tuberculosis
Mycobacterium tuberculosis (M. Tuberculosis), the organism that causes TB, is transmitted
through airborne respiratory droplets when an individual with active pulmonary TB coughs,
sneezes, or speaks. The transmission of M. tuberculosis depends on the length of time and
frequency of the exposure, the degree of contagiousness of the infected person, the
environment and airflow in which the exposure occurred, and the intensity of the contact
with the TB organism itself. Infection with M. tuberculosis usually requires prolonged contact
with an infectious case in an enclosed space. This exposure usually results in LTBI. The
majority of persons who become infected with LTBI never develop active TB.
2. Screening, Testing, and Treating Offenders for TB
The guidelines for screening, testing, counseling, evaluation and treatment in this SOP are
based on the most recent information from the National Institute of Health (NIH), Centers for
Disease Control and Prevention (CDC), and other nationally recognized science-based
literature.
The Federal Bureau of Prisons clinical practice guideline is based on recommendations
made by NIH and CDC, as well as current scientific research from a wide variety of sources,
and is the standard adopted by the IDOC for the identification, evaluation, and treatment of
LTBI and active TB.
Screening
Screening for TB in correctional facilities involves both ongoing surveillance for active TB
disease and detection of LTBI. Early detection and isolation of inmates with suspected
pulmonary TB is critical to preventing widespread TB transmission. Identification of LTBI
provides an opportunity for providing treatment to prevent future development of TB
disease.
TB Symptom Screening
All offenders received at the Reception/Diagnostic Unit (RDU) shall be systematically
screened for TB symptoms by a qualified health professional.
Screening for LTBI
All offenders received at the Reception and Diagnostic Unit will be screened for LTBI.
Risk factors for LTBI include the following:
• Intravenous drug abuse
• Chemotherapy
• Malnutrition
• Recent exposure to active TB
Control Number:
401.06.03.076
Version:
2.0
Title:
Tuberculosis
Page Number:
5 of 7

• Human immunodeficiency virus (HIV) infection
• Systemic steroid medication use.
Offenders will receive the two (2)-step Mantoux tuberculin skin test (TST) by intradermal
injection of purified protein derivative (PPD) of killed tubercle bacilli, usually on the inner
forearm. The forearm (or site) will be examined by a qualified health professional 48 to
72 hours later for a reaction.
The diameter of the induration is measured, disregarding erythema or bruising, as
follows:
• An induration of five (5) mm in any imunocompromised patient is considered
positive.
• An induration of 10 mm or more in recent immigrants and persons participating
in high-risk behaviors is considered positive.
• An induration of 15 mm or more in an otherwise healthy individual is considered
positive.
Note: Periodic repeat screenings will be accomplished based on incidence of TB and
incidence of impaired immunity from other diseases.
Note: All offenders will receive mandatory annual PPD testing in their birth month. If
previously positive, a questionnaire will be completed annually and a chest x-ray done
every five (5) years.
Chest Radiograph Screening
The following categories of offenders should have a chest x-ray at intake (in addition to
the intake TB symptom screen and a TST):
• All HIV positive offenders
• All offenders with a positive result on the TST.
Treatment of LTBI or Active TB
When privatized, treatment for LTBI or active TB will be under the direction of the
contract medical provider.
Medication compliance is a major issue in the treatment of LTBI and active TB. When
non-compliance occurs in an offender with either LTBI or active TB, the offender shall be
placed in the appropriate type of restrictive housing (see SOP 319.02.01.001, Restrictive
Housing) per their diagnosis or as clinically indicated because he poses a serious threat
to the health of others.
3. Testing IDOC Employees for TB
The testing of all new IDOC employees who work with offenders (including contracted staff)
is mandatory. The two (2)-step Mantoux TST shall be used (see section 2). TSTs should
then be repeated annually for all IDOC employees who work with offenders.
The contract medical provider will be responsible for administering the TSTs to both
offenders and IDOC staff.
Control Number:
401.06.03.076
Version:
2.0
Title:
Tuberculosis
Page Number:
6 of 7

4. Reporting Suspected or Active TB
The facility health authority and/or facility medical director shall:
• Ensure that the health authority is immediately notified of any suspected or active
cases of TB, and
• Ensure all suspected or diagnosed cases of TB are reported to the Department of
Health and Welfare so that they may assist in the proper management of the case
and in the evaluation of contacts.
Note: In accordance with the Health Insurance Portability & Accountability Act (HIPAA) of
1996 (Public Law 104-191), an IDOC offender has a right to understand and control how his
health information is used. Therefore, the IDOC considers an offender’s medical file and
data to be confidential and shall not become the topic of conversation other than for
professional purposes among healthcare services staff. Under no circumstances shall the
contents of an offender’s medical file be discussed with or disclosed to any other offender.
5. Transport of Offenders with Active TB
• Normal security precautions shall be utilized.
• The offender as well as security staff shall be provided with a special facemask to
prevent the transmission of airborne droplets, which may occur due to the offender
coughing, sneezing, etc.
6. Medical Isolation of TB Patients
When an offender has been diagnosed or when sufficient suspicion is present that indicates
the possibility of TB, the offender shall be isolated in unit infirmaries or local hospitals. All
healthcare services and security staff having contact with the isolated offender shall be fitted
with a special facemask to prevent the transmission of airborne droplets, which may occur
during contact.
Respiratory Isolation
Infected offenders shall be placed in respiratory isolation rooms until they are no longer
infectious. The standard to prove that an offender is no longer infected shall be
demonstrated by three (3) consecutive Acid-fast Bacillus tests showing a negative result
or sufficient antibiotic therapy decreasing the risk of transmission.
Note: Respiratory isolation rooms should be under negative pressure so that all air
currents come into the room (i.e., air should be ventilated to the outside of the building,
not re-circulated).
Ultraviolet (UV) Lighting
The installation of UV lights in respiratory isolation rooms should be used only as a
supplement to good ventilation (see the note box above). Cough inducing procedures
(such as sputum, bronchoscopy, and the administration of aerosolized pentamidine) can
place healthcare services staff and other offenders that are nearby at special risk of
acquiring TB. It is very important to carry out such procedures in respiratory isolation
rooms with negative pressure, relative to adjacent rooms and hallways. If installed,
proper precaution and maintenance of the UV lights is essential.
Control Number:
401.06.03.076
Version:
2.0
Title:
Tuberculosis
Page Number:
7 of 7

7. Food Service for Medically Isolated TB Patients
All food will be prepared by facility food service staff and brought to the medical facility in
disposable containers. Disposable utensils shall also be delivered.
8. Laundry Control for Medically Isolated TB Patients
All linen used for medically isolated TB patients shall be placed in water-soluble bags and
laundered separately.
9. Educating Offenders and IDOC Employees on Containing TB
Educating both offenders and staff and openly addressing their questions and concerns is
vital to efforts to contain TB. Education shall be a joint effort of healthcare services staff,
facility heads, division chiefs, and the Idaho Peace Officer Standards and Training (POST)
academy, and can be conducted in conjunction with the annual Acquired Immune Deficiency
Syndrome (AIDS) update.
Offenders should receive education on TB and other communicable diseases during the
intake process. (See SOP 401.06.03.032, Receiving Screening, for additional information.)
10. Compliance
Compliance with this SOP and all related Department-approved protocols will be monitored
by the health authority (or designee) by using various sources to include: this SOP, clinical
practice guidelines, routine reports, program reviews, and record reviews.
The health authority (or designee) must conduct two (2) audits a year (or more frequently as
desired based on prior audit results). The audits must consist of monitoring applicable
contract medical provider and IDOC policy and procedures, applicable NCCHC standards,
and the review of a minimum of 15 individual records.
REFERENCES
Centers for Disease Control and Prevention, Treatment of Tuberculosis (MMWR June 20,
2003/52[RR11];1-77)
Federal Bureau of Prisons, Management of Tuberculosis (2007)
National Commission on Correctional Health Care (NCCHC), Standard P-B-01, Infection
Control Program
Public Law 104-191, Health Insurance Portability & Accountability Act (HIPAA) of 1996
– End of Document –