Tuberculosis control

Directive number: QH-HSD-040:2013

Effective date: 14 December 2021

Review date: 14 December 2024

Supersedes: Version 3

On this page:

• Purpose
• Scope
• Principles
• Outcomes
• Mandatory requirements
• Supporting documents
• Business area contact
• Review
• Approval and implementation
• Definitions of terms in this directive
• Version control

Purpose

Tuberculosis (TB) is a nationally notifiable disease. The purpose of this health service directive is to ensure a consistent and best practice approach to the control of TB in Queensland through:

• Implementation of standardised clinical management of TB patients.
• Public health strategies for the prevention and control of TB including Multi Drug Resistant- TB (MDR-TB) and Extensively Drug Resistant TB- (XDR-TB) cases in Queensland.
• Appropriate epidemiological surveillance for TB.

Scope

This directive applies to all Queensland Hospital and Health Services (HHSs).

Principles

• Access—patients have access to a state-wide efficient, effective and equitable TB service with no out of pocket expense to the patient.
• Appropriateness of Diagnosis and Treatment—patients receive standardised diagnostic and treatment regimens that promote cure whilst minimising TB transmission within the community.
• Effectiveness of Treatment—patients receive treatment through a case management model that minimises the risk of drug resistance developing, as well as treatment failure and relapse of disease.
• Surveillance—all TB cases are notified to the Department of Health with mandatory data stored in the statewide Notifiable Conditions System (NoCS) and analysed to ensure the effectiveness of disease control is closely monitored.
• Information management—case management information is collected, stored and used for clinical, strategic, operational and service improvement purposes.
• Prevention of disease transmission—systems and processes are implemented and monitored to mitigate the risks of healthcare and community associated infection.
• Communication—appropriate and timely communication between HHSs and the Department of Health (Communicable Diseases Branch (CDB))
• Strategic vision—align activities to the current National Strategic Plan for TB Control as endorsed by the National Tuberculosis Advisory Committee.

Outcomes

Each Hospital and Health Service shall achieve the following outcomes:

• All cases of presumed (i.e. clinically diagnosed) and confirmed TB are managed in co-operation with an established TB Control Unit (TBCU).
• Implementation of statewide standardised diagnosis, treatment and ongoing management protocols to minimise the risk of drug resistance, treatment failure and/or relapse of disease.
• Adherence to endorsed state and national guidelines for preventing the transmission of TB in healthcare and community settings and to prevent TB in at-risk children through bacille Calmette-Guérin (BCG) vaccination.
• Notify the Department of Health of all cases of TB in accordance with the legislative obligations of the Public Health Act 2005.
• Inform the CDB within one business day of TB cases that pose an increased public health risk, where there is potential for involvement or implication of another jurisdiction, country or other governmental department or non-governmental organisation, or where there is potential for heightened community interest in accordance with the Protocol for the Control of TB.

Mandatory requirements

Each Hospital and Health Service shall:

• Adhere to the Health Service Directive- Protocol for the Control of TB.
• For those HHSs that do not have a TBCU, have in place a formal arrangement with a TBCU for the provision of essential TB services including but not limited to screening, vaccination and case and contact management.
• Provide timely access to assessment, treatment and follow up, with no out of pocket expenses to those with suspected or confirmed TB and to the following persons who require TB screening for exclusion or diagnosis of latent TB infection:
  • current and prospective employees in healthcare facilities in Queensland,
  • students undertaking placements in Queensland healthcare facilities,
  • migrants on health undertakings,
  • migrants (and their families) from high TB burden countries and,
  • contacts of identified cases.
• Ensure contact tracing and screening meet standards and time stipulations outlined in the Protocol for the Control of TB.
• Develop and maintain a contemporary, evidence-based Infection Control Management Plan (ICMP) that is in accordance with National Infection Control Guidelines.
• Have processes in place to ensure that all prospective workers in health care facilities, including contractors, students and volunteers, whose role may pose a risk of acquisition and/or transmission of TB are assessed and screened appropriately in accordance with the Protocol for the Control of TB.
• Ensure that all staff who perform Tuberculin Skin Test (TST) or BCG vaccination services have completed the relevant BCG/TST requirements as outlined in the Protocol for the Control of TB.
• Ensure staff administering BCG and/or TST are working within an appropriate, current and approved legislative framework.
• Develop and maintain a site-specific endorsed vaccine management protocol (VMP) that is in accordance with current state and national vaccine management guidelines, as outlined in the Protocol for the Control of TB.
• Notify the Department of Health (CDB), within five business days, of diagnosing all presumed cases of TB (i.e. clinically diagnosed).
• For those HHSs that have a TBCU, they shall ensure:
  • that the TBCU is staffed by a medical officer with appropriate specialist college qualifications or who is otherwise trained and experienced in TB management. In times when appropriate medical staff are not available, have in place a formal arrangement with another HHS TBCU to ensure adequate medical specialist cover for TB management
  • that the TBCU is staffed with appropriately skilled staff to meet the requirements of TB control
  • TBCUs should ensure sufficient staff can access the NoCS.
  • that the TBCU utilises the NoCS for the purpose of case notification and the storage of the minimum data requirements for each case of TB (refer to the Protocol for the Control of Tuberculosis section 3.3.2 and 3.3.3).
  • if a HHS elects to utilise an alternative data base for contact management, it must
  • comply with all relevant information management standards and requirements including the Queensland State Archives Health Sector (Clinical Records) Retention and Disposal Schedule and Queensland Government and Queensland Health Information Management policies.

Supporting documents

• Protocol for the Control of Tuberculosis

Legislation

• Financial Accountability Act 2009
• Health (Drugs & Poisons) Regulation 1996
• Hospital and Health Boards Act 2011
• National Health Securities Act 2007
• Public Health Act 2005 and Public Health Regulation 2018
• Right to Information Act 2009
• Work Health and Safety Act 2011
• Queensland State Archives Health Sector (Clinical Records) Retention and Disposal Schedule
• Public Records Act 2002

Queensland Health Guidelines

• Treatment of TB in adults and children
• Management of latent tuberculosis in adults
• Management of latent tuberculosis in children up to 16 years
• Treatment of tuberculosis in patients with HIV co-infection
• Treatment of tuberculosis in pregnant women and newborn infants
• Treatment of tuberculosis in renal disease
• Management of contacts of multi-drug resistant tuberculosis
• Amikacin use for drug resistant tuberculosis and nontuberculosis mycobacterial infections
• Queensland Health Clinical records management policy

National Tuberculosis Advisory Committee guidelines and position statements

• The Strategic Plan for Control of Tuberculosis in Australia, 2016–2020: Towards Disease Elimination
• Essential components of a tuberculosis control programme within Australia
• The BCG vaccine: information and recommendations for use in Australia
• Management of tuberculosis risk in healthcare workers in Australia
• Position statement on interferon-γ release assays for the detection of latent tuberculosis infection
• National position statement for the management of latent tuberculosis infection
• Infection control guidelines for the management of patients with suspected or confirmed pulmonary tuberculosis in healthcare settings
• CDNA National Guidelines for the Public Health Management of TB
• Australian Immunisation Handbook

Other resources

• Health Protection Branch-Environmental Health Training Program- Contact Tracing Officer – Application for Appointment
• Contact tracing guide for Contact Tracing officers
• Health Service Directive- Credentialing and defining the scope of clinical practice
• Torres and Cape Hospital and Health Service: Management of Papua New Guinea traditional inhabitants presenting to Queensland Health facilities within the Australian islands of the Torres Strait Protected Zone
• Torres and Cape Hospital and Health Service: Management of Papua New Guinea Nationals accessing healthcare within the Australian islands of the Torres Strait Protected Zone, presumed to have or diagnosed with tuberculosis.
• Infection control management plans (https://www.health.qld.gov.au/clinical-practice/guidelines-procedures/diseases-infection/infection-prevention/management-plans-guidance/icmp ).

Business area contact

• Deputy Director-General, Prevention Division
• Communicable Diseases Branch, Prevention Division
• Communicable Diseases Infection Management (CDIM)

Email: ndpc@health.qld.gov.au

Review

This Health Service Directive will be reviewed at least every three years.

Date of last review: 14/12/2018

Supersedes: Version 3

Approval and implementation

Directive Custodian

Dr John Gerrard, Chief Health Officer, Queensland Health

Approval by Chief Executive

Dr John Wakefield, Chief Executive

Approval date: 14 December 2021

Issued under section 47 of the Hospital and Health Boards Act 2011

Definitions of terms used in this directive

Version control