Tuberculosis (TB) Clinic

Policy

Category: Control of Infectious Diseases
Subject: Tuberculosis (TB) Clinic
Division: Health Protection
Policy Number: CA.82.01.201
Effective Date: February 26, 2016

POLICY STATEMENT

It is the policy of Wellington-Dufferin-Guelph Public Health (WDGPH) to provide comprehensive tuberculosis TB clinical services to clients in the community that have had a TB exposure or who have latent or active TB disease (on treatment). The TB clinic will be staffed by Control of Infectious Diseases (CID) Public Health Nurses (PHNs) in conjunction with a respirologist. The TB clinic will be operationalized using administrative, environmental, and personal protection controls to minimize risk to staff, physicians, and WDGPH clients.

SCOPE

This policy applies to all CID team members and nursing students who assist in the operation of the TB clinic.

DEFINITIONS

TB Clinic – A clinic operating regularly at the WDGPH Guelph office for the assessment and management of persons with possible, suspect, or confirmed active or latent tuberculosis disease.

Respirologist – A physician who specializes in the study of pulmonology and the treatment of respiratory disease

REFERENCES AND RELATED FORMS, POLICIES AND PROCEDURES

Corresponding Procedure: CA.82.02.201 Tuberculosis (TB) Clinic
Health Protection and Promotion Act, 1990
Ontario Public Health Standards, 2008
Canadian Tuberculosis Standards (as current, online edition)
Canadian Immunization Guide (as current, online edition)
Tuberculosis Prevention and Control Protocol (MOHLTC, as current)
Guidance for Tuberculosis Prevention and Control Programs in Canada (Pan-Canada Public Health Network, 2011)

CONTACT FOR INQUIRIES

Manager, Control of Infectious Diseases

APPROVED BY

Director, Health Protection 


Procedure

Category: Control of Infectious Diseases
Subject: Tuberculosis (TB) Clinic
Division: Health Protection
Procedure Number: CA.82.02.201
Effective Date: February 26, 2016

PROCEDURE

  1. For a referral to the TB clinic the referring physician may contact the respirologist’s office to make an appointment or refer directly to WDGPH.  If a client has no family physician, a referral to TB clinic may be made by the Medical Officer of Health (MOH) by completing the Request for Consultation form (HPDTB(F)12).
  2. The Public Health Nurse (PHN) will be responsible for preparing the clinic setting prior to the first appointment. This includes turning the HEPA/UVGI unit on for the duration of the clinic.
  3. The PHN will meet with the client, observing routine and additional precautions as needed for symptomatic and/or suspect or active cases.  If it is a new referral, the PHN will complete forms for the client including the Case Information form (HPDTB(F)1), Progress Notes (HPDCD(F)10), and Tuberculosis Initial Assessment (HPDTB(F)24). If this is a repeat visit, the PHN will complete the Tuberculosis Clinic Follow-Up form (HPDTB(F)25), count client’s medications and record on Monitored Medication Count sheet (HPDTB(F)7), if appropriate.
  4. Following the assessment, the respirologist will complete a Chest X-ray Requisition form and lab requisition, as required.
  5. The PHN will fill any prescription or refill medication orders as appropriate, provide education, and reinforce compliance.  The PHN will also ensure the client has the chest x-ray and/or appropriate lab requisitions for tests ordered by the respirologist.
  6. Should sputum for TB studies be ordered by the respirologist*, the PHN will give the client three sputum bottles and review the Collection of Sputum Samples for TB Test fact sheet (HPDTB(FS)8). 

*Note: If sputum for cytology is ordered by the respirologist, the specimens will have to be collected in bottles containing a specific medium.  The client can obtain these bottles through the lab when the requisition is presented.  The PHN can review the How to Collect Sputum for Cytology fact sheet (HPDTB(FS)6) with the client.

  1. The PHN will book follow-up appointments as necessary.  The PHN will complete the Clinic Appointment Reminder (HPDTB(F)14) for all return appointments and reinforce the importance of bringing all pills and x-rays to each appointment.  At the end of the clinic, the PHN will fax all updated copies of the Clinic Appointment Schedule (HPDTB(F)10) to the respirologist’s office staff.
  2. The PHN will complete the TB Clinic Statistics form (HPDTB(F)22) kept at the back of the appointment book at the end of each clinic.
  3. If an active case or suspect active case has been seen in clinic the HEPA/UVGI unit should be left running for 2 hours following the clinic and the door(s) closed and posted accordingly.

RESPONSIBILITIES

Management will:
  • Ensure that staff assigned to TB clinics are properly oriented and have the required skills and abilities to work in the TB clinic;
  • Ensure employees assigned to TB clinic are N95 mask fit-tested and have access to mask supplies;
  • Ensure employees who are assigned to work in the TB clinic have an annual TST. The results of the annual testing must be confidentially forwarded to the Occupational Health Designate for the Agency;
  • Ensure negative pressure is verified by testing every six months;
  • Ensure employees adhere to this policy and procedure; and
  • Monitor policy compliance on a regular basis
Employees will:
  • Be oriented to and have the required skills and abilities to work in the TB clinic;
  • Adhere to this policy and procedure;
  • Consult with Program Manager as required for any operational issues;
  • Use routine practices and additional precautions;
  • Have a supply of N95 masks (for which they have been fit-tested) available for the clinic;
  • Ensure negative pressure is operating during a clinic and that HEPA/UVGI is turned on
  • Ensure clients are risk-assessed for symptoms of active disease when booking appointment and when arriving for their appointment; and
  • Use routine and additional precautions as needed following the risk assessment.

DEFINITIONS

TB Clinic – A clinic operating once a month or as required for the assessment and management of persons with possible, suspect, or confirmed active or latent tuberculosis disease.

Respirologist – A physician who specializes in the study of pulmonology and the treatment of respiratory disease

REFERENCES AND RELATED FORMS, POLICIES AND PROCEDURES

Corresponding Policy CA.82.01.201 TB Clinic
CA.50.01/02.101 Documentation Practices
HPDTB(F)12 Request for Consultation form
HPDTB(F)1  Case Information form
HPDCD(F)10 Progress Notes
HPDTB(F)24 Tuberculosis Initial Assessment
HPDTB(F)25 Tuberculosis Clinic Follow-Up form
HPDTB(F)11 Chest X-ray Requisition form
HPDTB(FS)8 Collection of Sputum Samples for TB Test fact sheet
HPDTB(FS)6 How to Collect Sputum for Cytology fact sheet
HPDTB(F)14 Clinic Appointment Reminder
HPDTB(F)10 Clinic Appointment Schedule
HPDTB(F)22  TB Clinic Statistics form
Canadian Tuberculosis Standards
(as current, online edition)
Tuberculosis Prevention and Control Protocol
Routine Practices and Additional Precautions (as current, PIDAC)

CONTACT FOR INQUIRIES

Manager, Control of Infectious Diseases

APPROVED BY

Director, Health Protection