Tuberculosis control in a large urban jail: discordance between policy and reality.
OBJECTIVE
This study evaluated adherence to tuberculosis control guidelines, published by the Centers for Disease Control and Prevention in 1996, in a large urban jail. Jails are a critical locale because of high risk for tuberculosis transmission in a congregate setting.


METHODS
Symptom screening at intake into the facility was systematically observed. Medical records were reviewed to measure timing of tuberculin skin testing (TST) and chest radiograph (CXR) screening. Isolation records were examined for airborne infectious isolation practices. Contact investigation practices were evaluated for ease of data retrieval and adherence to CDC guidelines.


RESULTS
A TB symptom screening question was asked correctly during 28/97 of intake health interviews. Median time from intake to TST was 3 days for men and 2 days for women. Median time from referral to CXR was 2 days for men and 7 days for women. Delays were noted in diagnostic testing of 51 detainees isolated for suspected TB. Contact investigations lacked comprehensive procedures, data collection forms, and databases for managing information.


CONCLUSIONS
Findings were used to refine protocols for TB control. This evaluation illustrated the need for ongoing assessment of adherence to TB control protocols in short-term correctional settings to prevent the spread of TB.
Rutz
Heather J
HJ
Maryland Department of Health and Mental Hygiene, Division of Tuberculosis Control, Refugee and Migrant Health, Baltimore, MD 21201, USA. hrutz@dhmh.state.md.us
Bur
Sarah
S
Lobato
Mark N
MN
Baucom
Sharon
S
Bohle
Elizabeth
E
Baruch
Nancy G
NG
D000328:Adult; D015142:Baltimore; D002487:Centers for Disease Control and Prevention, U.S.; D003140:Communicable Disease Control / Q000379:methods* / Q000592:standards; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D011330:Prisons; D017678:Sex Distribution; D013997:Time Factors; D014374:Tuberculin Test; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000517:prevention & control*; D014481:United States; D014505:Urban Population