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Tuberculosis control protocol

Protocol number: QH-HSDPTL-040-1:2013

Effective date: 14 December 2021

Review date:  14 December 2024

Supersedes: version 3

On this page:

  1. Purpose
  2. Scope
  3. Roles and responsibilities for control of tuberculosis
  4. Supporting and related documents
  5. Definition of terms
  6. Approval and implementation
  7. Version control

1. Purpose

This protocol describes the mandatory requirements for the control of tuberculosis (TB) in Queensland. The term “TB” refers to active disease. Where latent TB is being discussed, it will be made explicit.

2. Scope

This Protocol applies to all Hospital and Health Services (HHS).

3. Roles and responsibilities for control of tuberculosis

3.1 Department of Health

The Office of the Chief Health Officer and Deputy Director-General, Prevention Division is responsible for strategic oversight and systems support for TB control in Queensland HHSs. This is facilitated by:

  • strategic leadership to support policy planning, development and implementation of effective TB control that is in alignment with the current National Tuberculosis Advisory Committee Strategic Plan for TB Control in Australia
  • coordination, where appropriate, of expert advice forums to support clinical and public health management of TB
  • coordination of state-wide programs and where appropriate peer network forums to support information sharing, capacity building and effective best practice management of TB
  • monitoring and analysing state-wide epidemiological trends to inform TB control management and strategic planning
  • monitoring State and Commonwealth regulatory and legislative obligations that are relevant to TB control services
  • facilitating relevant State and Commonwealth Partnership Agreements
  • facilitating access to educational resources and requirements that support attainment of knowledge and skills for registered nurses working in TB control including:
    • public health management of TB and bacille Calmette-Guerin (BCG) vaccination and tuberculin skin testing (TST)
    • contact tracing officer certification
    • custodianship and maintenance of a contact tracing officer register
  • contributing to quality assurance initiatives and where practicable, research that contributes to the continued delivery of evidence-based clinical practice, including methodologies and frameworks used to prevent, identify, manage or minimise infection events from occurring
  • monitoring issues impacting on the ability of TB control units to perform their role.

3.2 Hospital and Health Services

HHSs shall:

  • ensure clinical and public health management of TB cases and contacts is in accordance with published relevant state and national guidelines.
  • ensure diagnosis and treatment of latent TB in those at risk of progression to active TB is in accordance with Queensland Health guidelines.
  • ensure that all TB diagnostic services and treatment result in no out-of-pocket expenses to the patient.
  • ensure that all new cases of TB are notified to the Department of Health (DOH) Communicable Diseases Branch (CDB) as per the Public Health Act 2005 and Public Health Regulation 2018. This includes notifying cases where, in the absence of laboratory confirmation, a clinical diagnosis of TB is made.
  • ensure surveillance data (currently outlined in Post Notification forms) are completed as soon as possible directly into the Notifiable Conditions System (NoCS). This data is required to meet the mandatory reporting requirements of the National Notifiable Diseases Surveillance System (NNDSS).
  • ensure all TB patients are assessed and followed up to the completion of therapy and have post-treatment follow up for at least 2 years (or as long as clinically required) by a medical officer with appropriate specialist college or equivalent qualifications who is trained and experienced in TB management.
  • ensure 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 as per the Queensland Health TB Risk Assessment form.
  • provide reporting on request to the CDB regarding compliance with the requirements of the TB HSD and/or Protocol.
  • monitoring issues impacting on the ability of TB control units to perform their role.

3.3 Tuberculosis Control Units within Hospital and Health Services

3.3.1 Urgent advice to the Department of Health

The Department of Health, Communicable Diseases Branch are to be informed as soon as possible within one business day via the NDPC@health.qld.gov.au email account where any of the following apply:

  • there is suspicion or confirmation of a case of multidrug-resistant TB (MDR-TB) or extensively drug-resistant TB (XDR-TB)
  • there are more than 30 contacts of an infectious TB case
  • any cases of healthcare-associated transmission of TB
  • where a pattern of TB cases suggests a transmission cluster
  • where contact tracing is to be conducted in an institution or organisation
  • where there is potential for a level of community interest that will require a media holding statement or release of any information to other media sources by the HHS
  • where a case spent eight hours or more in an aircraft
  • where there is a potential or actual public health risk requiring involvement of, or having implications for, another jurisdiction, country or other governmental department or non-governmental organisation
  • any factors that may result in significant delay in implementing appropriate public health management of TB.

TBCUs are to provide the Department of Health with an update and/or outcome report regarding the above notifications, if requested.

3.3.2 Clinical information management

Minimum data requirements for each TB case are entered and stored in the NoCS. This minimum data requirement is defined within the NoCS system and can be entered directly by TBCU staff.

The NoCS provides utility for contact management and although it is not mandatory for HHS, it is strongly recommended it be used for this purpose.

Surveillance data for TB submitted to the CDB are stored in NoCS for state-wide reporting and provision of data to the NNDSS under the National Health Securities Act 2007.

Clinical record management must meet the requirements of the Queensland State Archives Health Sector (Clinical Records) Retention and Disposal Schedule, the Information Privacy Act 2009 (Qld) and the Public Records Act 2002 (Qld).

3.3.3 TB control surveillance

The responsibility for the collection and submission of TB data lies with the TBCUs. CDB has the responsibility for monitoring data quality, maintaining the data collection in NoCS and facilitating appropriate local and national reporting. Laboratory confirmed diagnoses of TB are sent electronically into NoCS. Clinical diagnoses of TB are manually generated in NoCS following submission of a PHA s70 form (or equivalent information emailed) by TBCUs. Notifications of clinical diagnoses of TB should be received by CDB within 5 business days of diagnosis.

Once a TB notification has been generated, TBCUs are required to submit TB surveillance data to meet national reporting requirements. The initial collection of required data, as outlined on the post notification form 1, should be entered directly into NoCS. This data is requested as soon as possible and within 14 days of diagnosis for all cases. Submission of the nursing interview form to CDB can facilitate completeness of surveillance data.

The collection of outcome data, as outlined on the post notification form 2, should be entered directly into NoCS. This data is requested within 14 days of the end of treatment or the end of the TBCU’s management of patients (that transfer out of their care).
From time to time CDB may require additional data including data as requested by the National Tuberculosis Advisory Committee (NTAC), a subcommittee of the Communicable Diseases Network Australia (CDNA).

3.3.4 Visa health assessments

TBCUs are required to:

  • perform triaging and provide TB diagnostic and management services to all clients that fall within their geographical region who are referred to them as part of the health undertaking and health manifest processes
  • provide TB diagnostic services to meet visa requirements, and where appropriate, recoup these costs from a third party such as a private health insurer. The HHS must ensure no out-of-pocket expenses to the client occurs
  • provide a clinic attendance report via email to the Department of Home Affairs (DHA).
  • ensure the timely notification of all ‘failures to present’ of Health Undertaking clients to the appropriate referring entity (Department of Home Affairs or Bupa Medical Visa Services).

3.3.5 Case management

Required public health response is aligned with the Communicable Diseases Network Australia (CDNA) National Guidelines for the Public Health Management of TB.

Treatment principles are outlined in published Queensland Guidelines (see section 3.3.8).

Response times

Prompt response is required when a new diagnosis of TB is made in order to ensure the best possible outcome for the patient and prevent transmission in healthcare facilities and the community by early implementation of therapy and appropriate infection control practice.

For TB cases where sputum/other respiratory tract sample is AFB smear positive:

  • ensure appropriate infection control has been implemented within 1 day of notification, noting that airborne infection control should be implemented in a healthcare setting upon suspicion of pulmonary TB
  • commence follow up of the case within 1 working day aiming to commence treatment within 3 working days or sooner depending on the acuity of the illness

For smear negative TB cases and extrapulmonary TB cases where TB is confirmed by PCR and/or culture:

  • ensure infection control is appropriate within 3 working days
  • commence follow up of the case within 3 working days aiming to commence treatment within 7 days of diagnosis notification

Where these response times cannot be met for legitimate reasons, response should be as soon as practical. Legitimate reasons include

  • patient is in a remote location distant to a treatment centre
  • non-adherence of the patient to follow up requests
  • drug resistance is confirmed or suspected and, where no harm will eventuate, treatment is delayed based on the judgment of the treating medical officer, pending further drug susceptibility data.

Case management key principles

Each TB patient, regardless of public or private status, must have an allocated case nurse from a TBCU. This role is to:

  • provide a supportive partnership and advocacy role between the patient and treating medical officer to deliver quality, timely and client focussed management,
  • provide health education and treatment support to facilitate adherence
  • Interview the patient as soon as practical to determine information which will inform public health actions (see 3.3.12 Contact Tracing)
  • Provide early identification of adverse effects of therapy
  • Facilitate access to HHS based services which may be required to address financial or social problems
  • Ensure a rapid molecular laboratory test has been performed to determine rifampicin susceptibility status
  • The use of Public Health Orders (behavioural or detention) under the Public Health Act 2005 can assist in the management of TB patients that are non-compliant with their treatment and pose an immediate public health risk. However, public health orders should only be used when all efforts to gain voluntary compliance, such as working collaboratively with non- government agencies in the community and the use of incentives and enablers have been exhausted.
  • ensure that TB patients are tested for co-infection with human immunodeficiency virus (HIV) with an appropriate pre-test and post-test discussion and subsequent management as per the Queensland Health Guideline for the treatment of TB in patients with HIV co-infection (see section 3.3.8).

3.3.6 Infection control

Clinicians managing patients in HHS facilities should ensure that, upon clinical suspicion of pulmonary TB, airborne precautions are implemented immediately.

Young children (particularly under 5 years of age) are very rarely infectious; hence immediate implementation of airborne precautions is not necessary in this group but should be considered within 24 hours. If not already in place respiratory isolation (airborne precautions) should be implemented upon notification of sputum smear positive pulmonary TB.
Patients with HIV-TB co-infection may not have typical symptoms. Pulmonary TB should be considered in the differential diagnosis of HIV positive patients who are at higher risk of TB (e.g. from higher burden TB countries) with respiratory symptoms or undiagnosed systemic illness.

Clinicians managing patients with a clinical suspicion and/or confirmation of pulmonary TB who are managed in the community (e.g. home isolation) must ensure the patient and family are provided with appropriate education and counselling about minimising the risk of transmission of infection; cough hygiene, avoiding new contacts and restricting movements away from home.
The patient should be isolated until assessed as being at minimal risk of transmitting infection.

For MDR-TB or complex cases where there is uncertainty in regard to the level of infectiousness an opinion may be sought from the Tuberculosis Expert Advisory Group (TEAG) (section 3.3.7).

Adequate social support and supervised therapy should be provided to patients in the home environment to increase adherence and compliance with infection control and treatment requirements.

For further detail refer to the current National Tuberculosis Advisory Committee Infection control guidelines for the management of patients with suspected or confirmed pulmonary tuberculosis in healthcare settings.

3.3.7 Tuberculosis Expert Advisory Group

The Tuberculosis Expert Advisory Group (TEAG) exists to provide expert advice on the management of complex TB cases to ensure that such cases are peer reviewed and best practice principles are recommended. If the treating team does not implement TEAG recommendations, feedback including the rationale for deviation from TEAG recommendations is to be provided to the TEAG via the Chair or via the NDPC@health.qld.gov.au email account.

HHSs are required to alert TEAG via the NDPC@health.qld.gov.au email account where there is:

  • a new case of rifampicin resistance (includes MDR-TB & XDR-TB)
  • where it is proposed that the Public Health Act 2005 be utilised to make an application for either a behavioural order or a detention order for a patient that poses an immediate risk to public health.

HHSs are encouraged to refer clinical cases where there is:

  • complex drug intolerance or other drug resistance
  • complex co-morbidities including a new case of TB-HIV coinfection.
  • complex cases (other complex clinical or social factors impacting on treatment)
  • paediatric diagnosis (cases or contacts)
  • where published evidence is lacking to guide clinical practice (including determination of infectious state)
  • failure of sputum cultures to convert to negative following two months of therapy for drug susceptible TB.

For further information contact the TEAG via NDPC@health.qld.gov.au

3.3.8 Principles of treatment

Queensland Health publishes guidelines for the management of tuberculosis.

HHS clinicians should follow these guidelines in most circumstances. Where a treatment related issue is not covered by the relevant guideline or where a treating medical officer wishes to pursue treatment contrary to the guideline, referral of the issue to TEAG is strongly encouraged.

The guidelines currently endorsed by TEAG are:

  • 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 non tuberculosis mycobacterial infections

Clinicians must identify and manage barriers to successful treatment adherence including ensuring diagnosis and treatment is cost free to the patient and ensuring directly or video observed therapy (DOT/VOT) or other aids to adherence are provided as required.

TB diagnostic services and treatment may be charged to a third party i.e. private health insurer. However, the HHS must ensure there will be no out-of-pocket expenses to the client.

Microbiological monitoring of treatment:

  • For pulmonary TB, sputum AFB, smear and culture should be tested at the end of the intensive phase (2 months) for drug sensitive TB.
  • If culture is still positive for non-MDR-TB, monthly cultures of at least two sputa collected should be performed until culture conversion is documented.
  • For MDR-TB cases, monthly sputum monitoring should be performed until three or more consecutive cultures taken at least 30 days apart are negative.
  • Wherever possible, sputa should be tested at the end of treatment to document culture negativity, consistent with WHO definition of cure

Failure to achieve such outcomes may be an indication of drug resistance or identify patients (even with drug susceptible disease) who would benefit from a longer duration of therapy.

Treatment records need to be made readily available to relevant clinicians, including the TEAG as required for patient management.

3.3.9 Directly observed therapy and video observed therapy

Decisions regarding use and mode of Directly Observed Therapy DOT and / or Video Observed Therapy (VOT) should be based on local and individual patient circumstances. DOT/VOT is strongly encouraged for patients at high risk of suboptimal therapy due to the following:

  • any form of rifampicin resistance including MDR-TB and XDR-TB
  • patients on three times per week therapy* [1]
  • any patient who has demonstrated they do not have capability to self-administer or are not able to maintain compliance with the recommended medication regimen
  • smear positive cavitary disease
  • anyone with a history of previous TB treatment.

The decision whether to use DOT or VOT or a combination, and whether it should be delivered in the community or health clinic, should be made in consultation with the patient, treating doctor, TBCU case nurse and other relevant HHS staff as required.

For additional information refer to the Communicable Diseases Network Australia (CDNA) National Guidelines for the Public Health Management of TB.

3.3.10 Patient travel and/or transfer

The TB clinician must inform the patient of all relevant infection control and/or continuity of care requirements, this will include any implications for travel or a requirement to refer to another TB Control Program.

If a patient with active infectious TB or incomplete treated active TB and may pose a public health risk, leaves the state or country without providing notice, the CDB will act on the advice of the TBCU/peripheral unit and facilitate appropriate communication to the National Incident Room or, alert other jurisdictional counterparts as appropriate.

It is the responsibility of the case management team to notify the CDB by email to NDPC@health.qld.gov.au as soon as possible within one business day to ensure timely and appropriate public health management.
In the Treaty areas of the Torres Strait Islands and Papua New Guinea patient movement will be managed in accordance with Torres and Cape HHS endorsed procedures.

3.3.11 Contact management

Contact management is to be undertaken by TBCUs in accordance with the Communicable Diseases Network Australia (CDNA) National Guidelines for the Public Health Management of TB.

Contact tracing assessment for contacts of sputum smear positive, pulmonary TB notifications should begin within seven working days of receipt of notification, with investigation of household contacts to commence as soon as possible.
All other cases should be followed up within fourteen days of receipt of notification.

3.3.12 Contact tracing

Contact tracing activities must only be undertaken by staff who have been appointed as a contact tracing officer (CTO) under the Public Health Act 2005.

Anyone seeking to be appointed as a Contact Tracing Officer (CTO) should refer to the Contact Tracing Guideline and complete the Application for Appointment form, located on QHEPS in the Public Health Operational and Regulatory toolbox.

Eligible applicants meeting the requirements of the Public Health Act 2005 will be assessed and subsequently appointed by the delegate of the Chief Executive, if appropriate. Eligibility is based on completion of the assessment package hosted by the Health Protection Branch (HPB), and endorsement by the designated supervisor. Upon issuing the identification card, the individual’s name will be added to the CTO register, maintained by the HPB.

Where the treating medical officer/s are not designated contact tracing officers, but have expertise in TB medicine, they must consult with the case management team within a TBCU to determine the infectivity of a TB case and assist as required with contact tracing.

While performing the interview as part of contact tracing, the CTO must:

  • review the case to determine the degree and duration of infectiousness, noting site of disease, AFB sputum smear status for pulmonary TB and symptom onset date.
  • assess environmental and behavioural factors that may modify the likelihood of transmission
  • promptly identify persons who have had significant close or prolonged contact with the person diagnosed with, or under suspicion of having TB and assess whether any such contacts have enhanced vulnerability to TB disease including children under 5 years of age and contacts who are immunocompromised
  • obtain a list of close household and close other contacts and invite them for screening within seven days of diagnosis or as soon as practical after this. Where deviations from these timelines are made, the reasons should be clearly documented
  • complete a Nursing interview with the patient diagnosed with active TB form, enter data into the TBCU’s database and attach to the patient file of the index case, and
  • attend to ‘concentric screening’ according to a risk assessment where large numbers of contacts are involved.

The case management nurse must then discuss findings of the interview and contact tracing with a senior TBCU clinician to plan the screening management. The senior TBCU clinician is to determine if extended screening is deemed necessary.

3.3.13 Contact screening

TBCUs are responsible for the management of contact screening for individuals residing within the TBCU’s region. Where contact screening involves a health care facility, the relevant infection control service work closely with the TBCU as required to determine who has been in contact with the index case and ensure appropriate follow-up.

Where a contact resides in a different region, the originating TBCU will forward information to the relevant TBCU who will undertake screening and provide test results and or screening outcomes back to the originating TBCU. Where a TBCU does not have resources to manage a large screening processes, the TBCU should immediately notify the HHS executive to seek the required resources.

CDB will facilitate interjurisdictional referral including the provision of TBCU key contact details as provided by the relevant TBCU where contact screening is required for persons in other State or Territory jurisdictions or countries. Sufficient case and contact data to inform appropriate contact management must be provided by the TBCU to the CDB to inform the relevant notification.
The case management team must determine (and communicate to the CDB) if secondary transmission has been identified through identification of clusters or reviewing epidemiological data.

TBCUs are responsible for ensuring appropriate post-screening follow-up and treatment occurs.

The case management nurse must ensure that accurate, up-to-date electronic records are kept of identified contacts and their individual screening outcomes. Such records must be made readily available, if requested, to the CDB.

3.3.14 Non-attendance of contact screening

TBCUs must ensure that the contact tracing activities, including follow up for non-attendance are conducted in a culturally and linguistically appropriate manner.

In the instances where the risk of transmission of TB is high and contacts fail to present for their screening appointment TBCU business processes must include a minimum of two documented additional invitations appropriately supported both culturally and linguistically (using as appropriate interpreters, refugee support agencies, and indigenous liaison officers encouraging a person to attend).

If the contact continues to fail to attend, a senior TBCU clinician (nursing or medical) must be consulted and a record of all attempts and outcomes documented.

3.3.15 Airline contact tracing

Generally, contact tracing among airline passengers is only necessary if the index case was, or thought to be smear positive at the time of the flight, and where the total flight time (inclusive of all time in the aircraft, during flight and on tarmac) was eight hours or greater.

Screening must be offered to passengers and airline staff who were seated in the same row and two rows before and two rows after (inclusive) of the index case and to airline staff as nominated by the relevant airline. Refer to the Communicable Diseases Network Australia National Guidelines for the Public Health Management of TB for additional information.

3.3.16 Bacille Calmette-Guerin vaccination and tuberculin skin testing

Administration of Bacille Calmette-Guerin (BCG) and Tuberculin Skin Testing (TST) must only be undertaken by appropriately trained staff with the relevant authority to administer.

Successful completion of theoretical training and subsequent successful assessment of clinical competency as detailed below is a requirement for registered nurses/ midwives to administer BCG or TST.

Currently clinical competency assessment provided by Queensland Health is restricted primarily to nurses working in, or intending to work in, Queensland TBCUs but may include other registered nurses/ midwives that support the TB control program, as determined by their respective TBCU.

A BCG and TST e-learning theoretical training package has been developed by the CDB and is comprised of online learning modules and mini-examinations. Successful completion of the online theoretical component is required prior to the health care worker completing all relevant practical clinical competency assessments, (administration of BCG or TST) as determined by and arranged with a TBCU.

The HCW must undergo reassessment at defined periods, as determined by the relevant TBCU in partnership with the HHSs, to remain clinically competent to perform TSTs and/or BCGs. The Credentialing HSD may apply as determined by the HHS.

All TBCUs must have a current vaccine management protocol (VMP) endorsed by the relevant Public Health Unit. HHSs will have in place a process to determine that all staff involved in vaccine management demonstrate appropriate competency as outlined in the VMP.

3.3.17 Laboratory diagnosis

TB is notifiable upon detection of Mycobacterium tuberculosis (M. tuberculosis) complex DNA by nucleic acid amplification (NAA) technology, isolation of M. tuberculosis complex by culture or by clinical criteria outlined elsewhere.

BCG strain M. bovis is an exception to this requirement whereas other members of the M. tuberculosis complex are notifiable. The finding of acid-fast bacilli from a clinical sample is also notifiable, but in itself does not distinguish TB from non-tuberculous mycobacteria.

It is essential that all efforts are made to establish a microbiological diagnosis. This confirms that the illness is due to TB and provides an organism for drug susceptibility testing. This is essential for ensuring correct antimicrobial treatment and enables genetic typing to assist in epidemiological investigations and public health control of TB transmission.

The Queensland Mycobacterium Reference Laboratory (Pathology Queensland) is the reference laboratory for all HHSs and receives all referred MTB isolates from Queensland based private pathology providers.

New smear positive respiratory samples will be tested with the GeneXpert MTB/RIF Ultra assay which is a NAA test which detects both the presence of M. tuberculosis and the presence of rifampicin resistance. This test can be clinician requested for AFB smear negative samples where the clinical suspicion of TB +/- drug resistance to rifampicin is high. GeneXpert or alternative NAA detection can be performed on non-respiratory samples depending on the nature of the sample – such testing should be discussed with the laboratory (07 36460032).

3.3.18 Workers and students in health care facilities risk assessment

Hospital and Health Services (HHSs) shall 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 using the Queensland Health TB risk assessment form. HHSs may have processes in addition to the current QH TB risk assessment criteria.

In order for both workers and HHSs to comply with provisions of the Work Health and Safety Act 2011 (WHS Act), workers are required to undertake and adhere to the TB risk assessment process.

Other areas of Queensland Health that fall outside of the HHSs such as Pathology Queensland and Forensic and Scientific Services (FFS) are strongly recommended to implement the same principles and processes to minimise the risk of transmission of TB.

The risk assessment form identifies those workers who require further assessment and medical testing for the presence of latent or active TB. Those who are from or have travelled to high risk TB countries for three months or longer (cumulative) are at the greatest risk for developing TB.

The risk assessment form must be completed prior to commencement of work or clinical placement with further screening, if required, to occur soon after. Where the assessment determines that a worker has risk factors, they will be advised of the required follow-up.

Workers and students should not have to be retested unless there is a change to their risk stratification since they were last tested as described in the TB risk assessment form and matrix.

The QH TB risk assessment form and supporting documents are available on the Queensland Health Tuberculosis website.

HHSs must have an arrangement in place with tertiary institutions to ensure that before accepting a student for a clinical placement, the student has undergone this risk assessment.

It is the responsibility of each HHS to securely and retrievably store records of risk assessments and referrals for Queensland Health employees.

BCG vaccination is not routinely recommended for any health care workers or students on clinical placement.

For definitions of Contractors, students and volunteers please refer to the HSD Protocol: Vaccine preventable disease screening for Contractors, students and volunteers

For definitions of workers please see HR policy B1 Recruitment and selection.

4. Supporting and related documents

Authorising Health Service Directive

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
  • Information Privacy Act 2009 (Qld)
  • Public Records Act 2002 (Qld)

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

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
  • Adverse Event Following Immunisation Reporting Form
  • Form PHA s70 Notifiable Conditions Report Form (1) for Queensland clinicians (Clinical and Provisional diagnoses)
  • Post notification information (Form 1)
  • Post notification Form 2
  • 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.

5. Definition of terms

Term Definition / explanation / details
AFB Acid Fast Bacilli
Authorised person Means a person appointed as an authorised person under section 377 of the Public Health Act 2005
BCG bacille Calmette–Guérin
Case Management Team Consists of the treating clinician, case manager nurse, case management medical officer, and allied health and others as required
Case Manager Nurse A senior nurse with appropriate knowledge and expertise who supports and advocates for a patient during their treatment regimen
CDB Communicable Diseases Branch
CNC Clinical Nurse Consultant 
CN Clinical Nurse
Clinical and related areas This category includes all healthcare workers who have contact with patients including:
  • medical practitioners
  • nursing staff
  • Indigenous Health Workers
  • allied health practitioners
  • dental staff (including assistants)
  • clinical pharmacy staff
  • maintenance personnel who service clinical  equipment (including plumbers)
  • sterilising services staff
  • mortuary staff and technicians
  • specimen collection staff
  • operational staff in other categories who  have contact with patients
  • cleaning staff and waste-management  personnel
  • porterage and patient assistance staff
  • security staff
  • laundry staff
  • home care workers
  • laboratory staff
  • ward catering staff
  • administration staff in patient care  areas
  • religious service providers
Clinician

A practitioner who spends  most of their total weekly working hours engaged in clinical practice (that  is, in diagnosis and/or treatment of patients including recommending  preventive action) is classified as a 'clinician'. A clinician may work  clinical and non-clinical hours.

Contact Screening Testing of close contacts for latent TB infection, or active TB disease. This is performed as soon as possible after contact tracing has occurred
Contact Tracing Determining, as per the Public Health Act 2005, who the TB index case’s close contacts are, via a structured interview
CTO A contact tracing officer appointed under the Public Health Act 2005
has the power to legally request information from an individual or a
business.
DHA Department of Home Affairs
DOT Directly Observed Therapy
Enhanced Surveillance Data Data contained within TB Post Notification Form 1 and the Outcome data contained in TB Post Notification Form 2.
Health Care Worker  Includes nursing, medical, paramedical and allied health professionals
Health Manifests A manifest provided by DHA to manage refugees who require screening
Health Undertaking An agreement that is made between the Australian Government and an immigrant/visa holder to ensure that visa holders with a history or an increased risk of tuberculosis do not develop active TB while in Australia
HHS Hospital and Health Service
MDR-TB Multi Drug Resistant -Tuberculosis
NAA Nucleic Acid Amplification
NNDSS National Notifiable Diseases Surveillance System
NoCS The Notifiable Conditions System (NoCS) is the information system that supports the requirement under the Queensland Public Health Act 2005 to maintain a notifiable condition register. NoCS facilitates the collection, analysis and reporting of notifiable conditions in Qld by CDB, PHUs, TBCUs/other business units.
No out of pocket expenses There will be no costs directly charged to the patient, however costs can be indirectly recovered from a third party (such as a health insurer), with the service provider arranging this, and ensuring that no costs are passed onto the patient.
RR Rifampicin resistant
TB Tuberculosis
TEAG Tuberculosis Expert Advisory Group
TBCU TB Control Unit
TST Tuberculin Skin Test
VOT Video Observed Therapy
XDR-TB Extensively Drug Resistant-Tuberculosis

6. Approval and implementation

Protocol Custodian

Dr John Gerrard, Chief Health Officer, Queensland Health

Approving Officer

Dr John Wakefield, Director-General, Queensland Health

Approval date: 14 December 2021

Effective from: 14 December 2021

7. Version control

VersionDate Prepared byComments
1 01/07/2013 Communicable Diseases Unit Three new documents
2 11/11/2015 Communicable Diseases Branch Reviewed HSD – one single protocol.  
3 14 /11/2018 Communicable Diseases Branch Reviewed HSD and Protocol
4 11/11/2021 Communicable Diseases Branch Reviewed HSD and Protocol

Footnotes

  1. For three times per week therapy, one or two defaults from attendance for the DOT dose(s) amounts to a loss of efficacy disproportionate to the number of dosages missed. Even a single failure from attendance must be followed up to investigate the reason for non-adherence and identify where other strategies or community support services may be of benefit.
Last updated: 14 December 2021