Assessment of tuberculosis screening and management practices of large jail systems.
OBJECTIVE
This descriptive study sought to explore the use and timeliness of tuberculosis (TB) screening and management activities in jail facilities.


METHODS
Study personnel visited 20 large U.S. jail systems and reviewed the medical records of 56 inmates who had recently been evaluated for TB disease and 376 inmates who were diagnosed with or confirmed to have latent TB infection (LTBI). Data from these records were analyzed to determine completion and timeliness of screening, diagnostic, and treatment activities.


RESULTS
In 14% of 56 inmates evaluated for TB disease and 24% of 376 inmates with LTBI, chest radiographs were either not performed or not documented. Of 48 inmates evaluated for TB disease who were not receiving treatment when admitted to jail, 10 had no record of sputum collection being done. A mean delay of 3.1 days occurred from symptom report to respiratory isolation. Time from tuberculin skin test reading to chest radiograph reading was a mean of 5.3 days in inmates evaluated for TB disease and a mean of 7.0 days in inmates with LTBI. Follow-up was arranged for 91% of released inmates who were on treatment for TB disease and only 17% of released inmates who were on treatment for LTBI.


CONCLUSIONS
Jail health information systems should be augmented to better document and monitor inmate health care related to TB. Completion rates and timeliness of TB screening, diagnostic, and treatment measures should be evaluated to identify areas needing improvement. Finally, mechanisms for continuity of care upon inmate release should be enhanced to promote therapy completion and prevent TB transmission in the community.
Reichard
Audrey A
AA
Field Services and Evaluation Branch, Division of Tuberculosis Elimination, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Lobato
Mark N
MN
Roberts
Cheryl A
CA
Bazerman
Lauri B
LB
Hammett
Theodore M
TM
D005568:Forms and Records Control; D006801:Humans; D008331:Management Information Systems; D008400:Mass Chest X-Ray / Q000706:statistics & numerical data; D008403:Mass Screening / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D008499:Medical Records / Q000592:standards*; D016134:Organizational Policy; D010356:Patient Isolation; D011330:Prisons / Q000458:organization & administration* / Q000592:standards; D011785:Quality Assurance, Health Care; D013902:Radiography, Thoracic / Q000706:statistics & numerical data; D012307:Risk Factors; D013183:Sputum / Q000166:cytology; D013997:Time Factors; D014374:Tuberculin Test / Q000706:statistics & numerical data; D014376:Tuberculosis / Q000175:diagnosis* / Q000517:prevention & control* / Q000628:therapy; D014481:United States