TB Contact Investigation Interviewing Skills Course

Day 1: Course Introduction

Text Only Version

Text Only Version of Day 1: Course Introduction
Slide Number	508 Compliance Text
1	(Title Slide). Introduction to Contact Investigation Process
2	Learning Objectives After this session, participants will be able to: Explain the purpose of a TB contact investigation Describe core concepts and skills that are required to conduct a TB contact investigation Determine when to initiate a TB contact investigation Describe the systematic approach to conducting a TB contact investigation
3	Priority TB Control Activities Identify and treat persons who have active TB disease Find and evaluate persons who have been in contact with TB cases and provide appropriate latent TB infection (LTBI) or TB disease treatment as needed Use targeted testing strategies to identify and treat persons with LTBI at risk for developing TB disease Identify settings at high risk for transmission of M. tuberculosis and apply effective infection-control measures
4	Contact Investigations: A Priority TB Control Activity Conducting contact investigations (CIs) is one of the highest priorities for TB programs in the United States -Second in importance only to detection and treatment of TB disease [IMAGE: A man and a woman having a discussion while sitting in chairs facing each other.]
5	What is a Contact Investigation?A systematic process to: Identify persons (contacts) exposed to cases of infectious TB disease Assess contacts for infection with M. tuberculosis and TB disease Provide appropriate treatment for contacts with LTBI or TB disease [IMAGE: Ten black spokes radiating from a pink circle.]
6	Who are TB Contacts?Contacts are persons who have shared airspace with a person with infectious TB disease. This might include Household members Friends Co-workers Others (e.g., cellmates, shelter residents) [IMAGE: A circle with a TB case in the middle showing people the case might encounter at work, home, and/or leisure activities around the circle.]
7	Why is it Important to Conduct TB Contact Investigations? (1)CIs help to: Interrupt spread of TB Prevent outbreaks of TB Ensure appropriate treatment for LTBI or TB disease
8	Why is it Important to Conduct TB Contact Investigations? (2) On average, 10 contacts are identified for each case 20% to 30% of household contacts have LTBI 1% of contacts have TB disease
9	Who is Responsible for TB Contact Investigations? State and local health departments have legal responsibility to Investigate TB cases reported in their jurisdiction Evaluate effectiveness of TB investigations Although the health department maintains legal responsibility, some CI steps may be delegated For example, with worksite exposures, occupational health offices are often involved
10	Group Discussion Share a few examples from your CI experience when you successfully identified active TB cases. What are some barriers to conducting CIs in your area?
11	(Title Slide). Core Concepts and Skills Required for Conducting TB Contact Investigations
12	What Core Concepts and Skills are Required to Conduct TB Contact Investigations? Knowledge of TB transmission Knowledge of TB pathogenesis Difference between LTBI and TB disease Risk factors for progressing to TB disease Effective interviewing skills Data management and analysis skills
13	Contact Investigation Core ConceptsTB Transmission
14	Remember: TB is Transmitted Person to Person! Every TB case Began as a TB contact [IMAGE: Stick people showing how TB can be transmitted.]
15	TB Transmission When a person with infectious TB disease coughs, sneezes, speaks, or sings, tiny particles containing M. tuberculosis (droplet nuclei) may be expelled into the air. If another person inhales droplet nuclei, transmission may occur; however, not everyone who is exposed to TB becomes infected with TB. [IMAGE: A person with infectious TB expels tiny particles containing M. tuberculosis (droplet nuclei) into the air and infects another person.]
16	What Factors Influence TB Transmission? The probability that TB will be transmitted depends on the following factors: Infectiousness of person with TB disease Duration and frequency of exposure Environment in which exposure occurred
17	Infectiousness of Person with TB Disease Characteristics associated with infectiousness: TB of the lungs, airway, or larynx Presence of cough Positive sputum smear Cavity on chest x-ray Positive cultures Not covering mouth when coughing Not receiving adequate treatment Undergoing cough inducing procedures [IMAGE: A woman coughing into her cupped hands.] [IMAGE: An x-ray of lungs with an arrow pointed at the diseased area of the lungs.]
18	Duration and Frequency of Exposure Contacts at higher risk for TB infection are those who: Frequently spend a lot of time* with the case Have been physically close to the case * “A lot of time” is difficult to define, but may be determined locally based on experience [IMAGE: A smiling man and woman sitting close and drinking a beverage.]
19	Environment in Which Exposure Occurred Environmental characteristics that increase chances of TB transmission: Small or crowded rooms Areas that are poorly ventilated Rooms without air-filtering systems [IMAGE: A House.]
20	STOP the Chain of TransmissionThe BEST way to stop transmission is to Identify and isolate infectious persons Start infectious persons on effective treatment for TB disease[IMAGE: Male and female stick people handing hands.]
21	Contact Investigation Core Concepts TB Pathogenesis
22	What Happens Once Someone is Exposed To TB? Not every person who is exposed to TB becomes infected Persons who become infected will generally have a positive Tuberculin skin test (TST) Or Blood test (interferon gamma release assay [IGRA]) Persons who become infected can have either: LTBI Active TB disease
23	Latent TB Infection (LTBI)LTBI – immune system keepstubercle bacilli under control LTBI characteristics Usually positive TST or IGRA Not infectious No symptoms Normal chest x-ray Sputum smears and cultures are negative Not a “case” of TB[IMAGE: A granuloma surrounding tubercle bacilli.]
24	Active TB DiseaseTB disease – immune system cannot stop tubercle bacilli from multiplying leading to active TB disease Usually affects lungs, but can affect other areas of the body Characteristics usually include: Positive TST or IGRA Infectious (before treatment) Symptoms Abnormal chest x-ray Positive sputum smear and culture Considered a “case” of TB[IMAGE: A granuloma opened up and releasing tubercle bacilli.]

Page last reviewed: January 14, 2019

Content source: Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention