Abstract
Tuberculosis (TB) infections remain a common but deadly disease. TB control in health care and correctional settings presents numerous public health challenges for occupational and correctional health nurses.
Keywords
Tuberculosis (TB) infections, caused by the airborne bacteria Mycobacterium tuberculosis, remain a common but deadly disease and are a leading cause of death for women aged 15 to 44 years (World Health Organization [WHO], 2015). Worldwide, only HIV/AIDS causes more deaths from infection; 9 million new TB cases and 1.5 million deaths occurred in 2013, primarily in the Southeast Asian, Western Pacific, and African regions (WHO, 2015). Misdiagnosis or ineffective treatment contributes to most TB transmissions, and insufficient ventilation and infection control practices, severe overcrowding, inadequate nutrition, and limited access to health care promote outbreaks. Workers in health care or congregate settings, including correctional and detention facilities, military barracks, homeless shelters, refugee camps, nursing homes, and dormitories, are most at risk (Centers for Disease Control and Prevention [CDC], 2012b). TB risk increases with tobacco use; smoking contributes to more than 20% of infections worldwide (WHO, 2015).
Occupational and correctional health nurses face numerous challenges controlling TB outbreaks. TB infections, sometimes up to 70 times higher among inmates, combined with high rates of smoking and HIV infections, contribute to the further development and spread of active TB in prisons (U.S. Agency International Development [USAID], n.d.). High turnover rates among prison and jail populations plus inadequate diagnosis or treatment, increase TB exposure risk among correctional workers, correctional health nurses, and community-based health care workers treating prisoners during incarceration or after release (USAID, n.d.).
HIV co-infected TB patients are also at greater risk of developing multidrug-resistant TB (MDR-TB) infections that do not respond to standard TB drugs, Isoniazid and Rifampicin (USAID, n.d.). In 2013, ineffective treatment contributed to approximately 480,000 individuals developing MDR-TB worldwide; more than half the cases were in India, China, and the Russian Federation. Although curable with appropriate medications, access to these costly medications is limited, severe side effects occur, and treatment of MDR-TB often takes 2 years (WHO, 2015). Unless cured, infected individuals spread the drug-resistant bacteria. Global travel also increases the risk of transmission worldwide.
Occupational and correctional health nurses can implement these proposed strategies to reduce TB outbreaks in global health care and correctional settings.
Identify workers at high risk of TB exposure, particularly in health care facilities, prisons, or shelters, and require an annual TB skin or interferon-gamma release assay test.
Encourage TB tests before international travel to a high-risk country or work setting and 8 to 10 weeks after workers return (CDC, 2012a).
Educate corporate health and safety professionals with international worksites in high-risk countries about TB hazards for workers and appropriate control measures.
Advocate for mandatory active surveillance programs, environmental controls that reduce airborne bacteria, and appropriate, timely treatment for suspected or confirmed TB infections in health care and correctional facilities or any worksite with high exposure risks.
Collaborate with correctional health nurses and public health, prison, and health care administrators on policies about TB control, mandatory reporting, adequate infection control practices, and access to appropriate respiratory protection (CDC, 2012a).
Cooperate with public health departments to properly document and report TB cases.
Monitor WHO and CDC websites and publications for best practices in TB control.
Footnotes
The author(s) declared no potential conflicts of interest and received no financial support with respect to the research, authorship, and/or publication of this article.