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September 1, 1995 MEMORANDUM FOR: NATIONAL OFFICE DIRECTORS REGIONAL TB COORDINATORS FROM: STEPHEN MALLINGER Acting Director Directorate of Technical Support SUBJECT: OSHA Tuberculosis Control Training and Resource Guide
Attached for your use is an OSHA document
entitled "OSHA Tuberculosis Control Training and Resource Guide". The
document was developed by a Nurse Intern at the request of the Directorate of
Health Standards. The
document is designed to assist field compliance safety and health officers
(CSHOs) with the distribution of pertinent educational and informational
materials on tuberculosis. The
document has been reviewed by the Office of Occupational Health Nursing staff
and selected field representatives. Since
the intent of the document is to assist CSHOs with inspections, our plan at
this time is only to provide copies of it internally to OSHA staff (National
Office and Regional TB Coordinators). Wider distribution will be considered,
if the need arises. Additionally,
this document is being made available through the DOL Electronic Bulletin
Board System at (202) 219-4784. Specific instructions to assist users in
accessing the document are also attached. Attachment Bulletin Board, several steps are required as outlined below: DOL BBS - Dial into system (202-219-4784) Complete log-on Select M Main Library of Files Select M Main Library of Files again Select S Select Library Type OSHA Select F Find files Select K Keyword Search Type any key word from title of document ______________________________ OSHA TUBERCULOSIS CONTROL TRAINING AND RESOURCE GUIDE - 1995 - _______________________________________________ INTRODUCTION This document was produced by Mary Dirksen and edited by Robert Nester, OSHA Nurse Interns, assigned to the Office of Occupational Health Nursing, Directorate of Technical Support during the summer of 1995. Project assistance was provided by Carla Slaughter, Office of Occupational Health Nursing. The materials contained herein have been reviewed for their relevance. Their inclusion has been based primarily upon the authority of the source rather than an in-depth review of the reference. OSHA does not endorse, certify, regulate, nor recommend any of these programs or products in whole or in part. The purpose is to provide OSHA staff with viable resources related to the control and management of tuberculosis (TB). The information contained in this resource guide is not to be considered a substitute for compliance, but rather may be useful in developing an effective TB control program. _______________________________ OSHA TUBERCULOSIS CONTROL TRAINING AND RESOURCE GUIDE ______________________________________________ Table of Contents I. Program and Management Resources A. General Management Assistance B. Prevention / Control C. Engineering Controls D. Respiratory Protection E. Population / Site Specific Assistance i. Health care facilities ii. Long-term care facilities iii. Drug treatment facilities iv. Correctional facilities v. Homeless shelters and homeless care facilities vi. Other high-risk populations Attachment A: Smoke Trail Test for Negative Pressure Isolation Rooms II. Training Programs and Materials III. Worker Education Materials/Resources A. General Information B. Screening C. Medications/Treatment D. Prevention/Control E. TB/HIV IV. Non-English Language Resources V. Publications and Resources for Clinicians VI. State and Territorial Health Departments - Offices of TB Control Appendices A. Addresses / Contact Information B. Centers for Disease Control and Prevention, Education and Training Materials Order Form (copy ready) I _________________________________________________________________________ PROGRAM AND MANAGEMENT RESOURCES _____________ The resources in Section I, Program and Management Resources, include general assistance in the development, implementation and management of a work place tuberculosis control program. _________________________________________________________________________ ____________________________________ PROGRAM and MANAGEMENT RESOURCES ____________________________________ A. GENERAL MANAGEMENT ASSISTANCE A Tool for Program Review Procedures in TB Control 1989 A formal outline procedure to evaluate a program's effectiveness. Review process promotes quality assurance and allows for feedback and formal recommendations to flow in both directions. Mississippi State Department of Health. __________________ Centers for Disease Control and Prevention (CDC) Tuberculosis Guidelines (Condensed) Virginia Epidemiology Bulletin 1994 Synopsis of the CDC 1994 Tuberculosis Guidelines; 3-pages. Designed to assist employers to be in compliance with the CDC guidelines. Virginia Department of Health, Office of Epidemiology. __________________ Enablers and Incentives 1989 36-page booklet appropriate for health care workers working with high-risk populations. Includes an article which describes the use of incentives and enablers, and a transcription of a recorded roundtable discussion by tuberculosis nurses in South Carolina who have first-hand experience in the use of incentives and enablers. American Lung Association of South Carolina. __________________ Guide for Tuberculosis Programming in the 1990s 1991 Organized outline of suggested program indicators used to gather information for use in evaluation of tuberculosis (TB) control programs. 17-page booklet aimed at TB control workers. American Lung Association, local chapter. __________________ OSHA Enforcement Policy on Tuberculosis - Fact Sheet 1993 Addendum to October, 1993 OSHA TB Compliance Directive. __________________ OSHA Enforcement Policy and Procedures for Occupational Exposure to Tuberculosis: A Checklist American Federation of State, County and Municipal Employees, AFL-CIO. __________________ Tuberculosis - Protection For Healthcare Workers 1995 A comprehensive packet designed to assist the Infection Control Practitioner in implementing current CDC recommendations for the control of tuberculosis in health care facilities. Complements a health care worker educational video [see Worker Education Materials and Resources - Association for Practitioners in Infection Control (APIC) for detail description of video]. Distributed by Lincoln Medical Education Foundation, Attn: Tuberculosis Video, 4600 Valley Road, Lincoln, Nebraska 68510; (402) 483-4581; FAX (402) 483-4184. Packet + video: $225.00 APIC members, $250.00 non-members; $35.00 preview/rental applied toward purchase. Association for Practitioners in Infection Control and Epidemiology, Inc.. __________________ Tuberculosis Skin Testing Facility Record Card Card to record employee skin testing information. For facilities with employee skin testing programs. Washington (State of) Department of Health, TB Control Program. __________________ B. PREVENTION / CONTROL Infection Control Video Association for Practitioners in Infection Control and Epidemiology, Inc.. __________________ Controlling Occupational Exposure to Tuberculosis 1993 Joint Commission on Accreditation of Healthcare Organizations. Monograph. $40.00. __________________ Industrial Hygiene Considerations in the Prevention of Tuberculosis Transmission 1994 A compilation of regulatory, research, and technical materials related to the environmental, occupational health, and industrial hygiene issues of workplace tuberculosis control. Hunter College School of Health Sciences, Center for Occupational & Environmental Health, (Daniel Kass, Director). Permission to photo-copy granted by Hunter College. __________________ Tuberculosis: A Teacher's Resource Handbook For teachers and school workers involved in tuberculosis prevention and education programs. American Lung Association of Los Angeles County. __________________ Tuberculosis (TB) Blueprint: Goals and Objectives 1993 Outlines the plan by the New York City Department of Health to control the spread of TB. States three major goals: 1) increase treatment completion rate, 2) prevent the spread of TB in congregate settings, and 3) preventing future cases of active TB through screening and preventive treatment. Includes objectives and implementation steps for each goal. New York City, Department of Health. __________________ The following materials are available at no charge from the Centers for Disease Control and Prevention (CDC), Information Services (address in Appendix A). A CDC Materials Order Form, suitable for copying, is enclosed in Appendix B. Centers for Disease Control and Prevention. (1994). Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care facilities. Morbidity and Mortality Weekly Report, 43(RR-13), October 28. Control of tuberculosis (TB) in correctional facilities. (1993). A 16-page booklet providing an overview of TB in correctional facilities and outlining a program of surveillance, containment, and prevention. Includes screening guidelines for staff of correctional facilities. Aimed at health care workers in corrections. Centers for Disease Control and Prevention. (1993). Tuberculosis control laws - United States, 1993: Recommendations of the Advisory Council for the Elimination of Tuberculosis (ACET). Morbidity and Mortality Weekly Report, 42(No. RR-15). Centers for Disease Control and Prevention. (1992). Prevention and control of tuberculosis among homeless persons and prevention and control of tuberculosis in U.S. communities with at-risk minority populations. Morbidity and Mortality Weekly Report, 41(No. RR-5), April 17. Centers for Disease Control and Prevention. (1992). Prevention and control of tuberculosis in migrant farm workers. Morbidity and Mortality Weekly Report, 41(No.RR-10), June 5. TB in correctional facilities. (1992). A set of 67 slides on TB prevention and control; a 67-page booklet of slide facsimiles; and an 18-page narrative text designed to accompany the slide set. May be ordered separately. American Thoracic Society (ATS). (1992). Control of tuberculosis in the United States. American Review of Respiratory Disease, 146(6), 1623-1633. Centers for Disease Control and Prevention. (1990). Prevention and control of tuberculosis in facilities providing long-term care for the elderly. Morbidity and Mortality Weekly Report, July 13, 1990. Centers for Disease Control and Prevention. (1990). Prevention and control of tuberculosis among foreign-born persons entering the United States. Morbidity and Mortality Weekly Report, 39(No. RR-18), December 28. What drug treatment centers can do to prevent tuberculosis. 4-page guidelines with recommendations from the CDC. Centers for Disease Control and Prevention. (1995). USPHS/IDSA guidelines for the prevention of opportunistic infections in persons infected with Human Immunodeficiency Virus: A summary. Morbidity and Mortality Weekly Report: Recommendations and Reports, 44(No. RR-8), July 14, 1995. C. ENGINEERING CONTROLS Controlling Occupational Exposure to Tuberculosis 1993 Joint Commission on Accreditation of Healthcare Organizations. Monograph. $40.00. __________________ Engineering Controls 1995 A 20-minute video from the OSHA Office of Training and Education (OTI), Des Plaines, Illinois. Includes a demonstration of smoke trail testing. __________________ Centers for Disease Control and Prevention. (1994). Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care facilities. Morbidity and Mortality Weekly Report, 43(No. RR-13), October 28. Includes an engineering control section and other sections when considering the special needs of such diverse health care settings as dental clinics, long-term care facilities, and others. MMWR reprint available at no charge from the CDC, Information Services. __________________ Reducing the Spread of Tuberculosis in Your Workplace 1995 15-page guidebook designed to assist small organizations, agencies, and businesses which serve people at risk for tuberculosis to evaluate and maximize their indoor air quality. Emphasis is on low-tech, low-cost administrative controls and the enhancement of natural ventilation systems. Contact Daniel Kass, Director, Hunter College School of Health Sciences, Center for Occupational & Environmental Health; $4.00/copy for less than 5, decreasing to $2.00/copy for 51 or more. Permission to photo-copy granted by Hunter College. __________________ Smoke-Trail Test for Negative Pressure Isolation Rooms Procedural guideline drafted by OSHA in January, 1994. Copy enclosed at the end of Section I - Attachment A. __________________ Using Ultraviolet Radiation and Ventilation to Control Tuberculosis (TB). 1990 Booklet discusses the use, effectiveness, and technical installation details about UV radiation in the control of TB. Discusses technical details about both local exhaust and dilution ventilation. California Indoor Air Quality Program, California Department of Health Services. Permission is granted to reproduce booklet, provided credit is given to the source. __________________ D. RESPIRATORY PROTECTION Centers for Disease Control and Prevention. (1994). Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care facilities, Notice. Morbidity and Mortality Weekly Report, 43(No. RR-13), October 28. MMWR reprints available at no charge from the CDC, Information Services. __________________ Exposure Control Manual 1995 A manual of materials offering providers of long-term care facilities the necessary tools for implementing a tuberculosis (TB) control program. Includes a sample risk assessment guide for use at the facility level, protocols for each of five categories of risk, NIOSH's technical guide to respiratory protection, and worksheets, checklists, and forms to help implement a facility-based TB infection control plan. Includes engineering and administrative guidelines. Also includes copies of the OSHA TB guidelines, and the Guidelines for control of TB in long-term care facilities. American Health Care Association. $15.00 for members; $25.00 for non-members. __________________ Respiratory Protection Devices 1995 National Institute for Occupational Safety and Health (NIOSH). Federal Register, June 8, 1995, 42 CFR Part 84, 60(110), 30336-30404. __________________ Tuberculosis Control in Hospitals 1994 A Tuberculosis (TB) resource packet providing materials to assist in tuberculosis control in hospital settings. Includes the CDC guidelines (1994), OSHA's enforcement policy and procedures (issued 10/93), OSHA's TB inspection survey checklist, guidelines on the elements of a respiratory protection program, and a resource list for training and education materials. American Hospital Association. To order, call (800) AHA-2626, request order # 094692; $15.00 for members, $55.00 for non-members. __________________ E. POPULATION / SITE SPECIFIC ASSISTANCE i. Health Care Facilities Centers for Disease Control and Prevention. (1994). Guidelines for preventing the transmission of Mycobacterium tuberculosis in health care facilities. Morbidity and Mortality Weekly Reports, 43(No. RR-13), October 28. MMWR reprints available at no charge from the CDC, Information Services. __________________ Protection for Healthcare Workers 1995 20-minute video addressing the following content areas: increased incidence of tuberculosis, transmission, prevention, skin testing, environmental controls, treatment, personal protection, medical monitoring, and others. Association for Practitioners in Infection Control and Epidemiology, Inc.; order video from Lincoln Medical Education Foundation. _________________ Tuberculosis Control in Hospitals 1994 A Tuberculosis (TB) resource packet providing materials to assist in tuberculosis control in hospital settings. Includes the CDC guidelines (1994), OSHA's enforcement policy and procedures (issued 10/93), OSHA's TB inspection survey checklist, guidelines on the elements of a respiratory protection program, and a resource list for training and education materials. American Hospital Association. To order, call (800) AHA-2626, request order # 094692; $15.00 for members, $55.00 for non-members. __________________ ii. Long-Term Care Facilities Exposure Control Manual 1995 A manual of materials offering providers of long-term care facilities the necessary tools for implementing a tuberculosis (TB) control program. Includes a sample risk assessment guide for use at the facility level, protocols for each of five categories of risk, NIOSH's technical guide to respiratory protection, and worksheets, checklists, and forms to help implement a facility-based TB infection control plan. Includes engineering and administrative guidelines. Also includes copies of the OSHA TB guidelines, and the Guidelines for control of TB in long-term care facilities. American Health Care Association. $15.00 for members; $25.00 for non-members. __________________ Guidelines for Prevention of TB Transmission in Nursing Homes 1986 Texas Department of Health. __________________ Centers for Disease Control and Prevention. (1990). Prevention and Control of Tuberculosis in Facilities Providing Long-Term Care for the Elderly. Morbidity and Mortality Weekly Report, 39(No. RR-10), July 13. Reprint available at no charge from the CDC, Information Services. __________________ TB Control Screening Guidelines for Convalescent Homes 1988 American Lung Association of Connecticut. __________________ iii. Drug Treatment Facilities What Drug Treatment Centers Can Do To Prevent Tuberculosis 1991 Discusses tuberculosis transmission and infection rates, high risk persons, infection versus disease, symptoms, screening, and preventive therapy. Available at no charge from the CDC, Information Services. __________________ iv. Correctional Facilities Clark, J.H. (1993). Strategies for guerrilla warfare. American Jails, January/February. Discusses controlling the spread of tuberculosis in correctional facilities. Dr. Clark is the Chief Medical Officer at the Los Angeles County Sheriffs' Office. (213) 974-0149. __________________ Infectious Diseases: A Management Issue Jail Managers Bulletin # III-2. Teaches managers how to recognize infectious diseases and how to prevent the spread of infectious diseases in correctional facilities. American Jail Association. __________________ Control of Tuberculosis in Correctional Facilities: A Guide for Health Care Workers 1993 A 16-page booklet providing an overview of tuberculosis (TB) in correctional facilities and outlining a program of surveillance, containment, and prevention. Includes information on HIV and TB. Also includes screening guidelines for staff of correctional facilities. Aimed at health care workers in corrections. Available from the U.S. Government Printing Office, Publication No. 1993-533-001 (80540). __________________ Communicable Diseases 1995 6-page Jail Operations Bulletin (# VI-4) which covers tuberculosis. Contains a self test for learner evaluation. American Jail Association. __________________ Guidelines for Prevention of TB Transmission in City and County Jails 1987 Texas Department of Health. __________________ TB in Correctional Facilities 1992 A set of 67 slides on tuberculosis prevention and control in correctional settings; a 67-page booklet of slide facsimiles; and an 18-page narrative text designed to accompany the slide set. May be ordered separately. Available at no charge from the CDC, Information Services. __________________ v. Homeless Shelters and Homeless Care Facilities Health Care for the Homeless: Annotated Bibliographies 1995 Annotated Bibliography # 6: Tuberculosis and homeless persons. 9-pages of references for the period January 1987 - April 1995. Annotated Bibliography # 12: Tuberculosis and HIV/AIDS. 45-pages of references for the period January 1987 - April 1995. Health Care for the Homeless Information Resource Center (HCHIRC). Questions to Yvonne Wallace, Librarian, HCHIRC. Order from John Snow, Inc.. __________________ Centers for Disease Control and Prevention. (1992). Prevention and control of tuberculosis among homeless persons and prevention and control of tuberculosis in U.S. communities with at-risk minority populations. Morbidity and Mortality Weekly Report, 41(No. RR-5), April 17. Reprint available at no charge from the CDC, Information Services. __________________ TB Training for Shelter Workers Slide presentation for training homeless shelter workers to identify symptoms of tuberculosis. Includes a skin testing protocol and a policy for tuberculin skin testing in homeless populations. Alma Illery Medical Center (Pittsburgh, Pennsylvania); contact Nurse Coordinator of Primary Health Care Services. __________________ Wasatch Homeless Health Care Program This community based program has developed guidelines for PPD testing and follow-up of the staff at the homeless shelter. Contact: Allan Ainsworth, Ph.D., Director, Fourth Street Clinic, 404 South 400 West, Salt Lake City, Utah 84101; (801) 364-0058; FAX (801) 364-0161. __________________ vi. Other High Risk Populations Centers for Disease Control and Prevention. (1990). Prevention and control of tuberculosis among foreign-born persons entering the United States. Morbidity and Mortality Weekly Report, 39(No. RR-18). December 28. __________________ Centers for Disease Control and Prevention. (1992). Prevention and control of tuberculosis among homeless persons and prevention and control of tuberculosis in U.S. communities with at-risk minority populations. Morbidity and Mortality Weekly Report, 41(No. RR-5), April 17. Reprint available at no charge from the CDC, Information Services. __________________ Enablers and Incentives 1989 36-page booklet appropriate for health care workers working with high risk populations. Includes an article which describes the use of incentives and enablers, and a transcription of a recorded roundtable discussion by tuberculosis nurses in South Carolina who have first hand experience in the use of incentives and enablers. American Lung Association of South Carolina. __________________ Guidelines for Prevention and Control of TB Among Individuals with HIV Infection 1989 Texas Department of Health, Tuberculosis Control Division __________________ Centers for Disease Control and Prevention. (1992). National action plan to combat multidrug-resistant tuberculosis: Management of persons exposed to multidrug-resistant tuberculosis. Morbidity and Mortality Weekly Report, 41(No. RR-11), June 19. Available at no charge from the CDC, Information Services. __________________ Centers for Disease Control and Prevention. (1992). Prevention and control of tuberculosis in migrant farm workers. Morbidity and Mortality Weekly Report, 41(No. RR-10), June 5, 1992. Reprint available at no charge from the CDC, Information Services. __________________ Managing Tuberculosis and HIV Infection in Today's General Workplace 1992 National Leadership Coalition on AIDS; $5.00 for members, $10.00 for non-members. __________________ Migrant Clinicians Network Publishes a newsletter with occasional information on tuberculosis issues among migrant workers. Migrant Clinicians Network, Michael Koroscik, Director of Education. __________________ Office of Minority Health Resource Center (OMH-RC) Resource and referral service on minority health issues, including tuberculosis. Offers database searches, information exchange, publications, mailing lists, technical assistance, data and statistics, and referrals. Resource Person Network (volunteers) available to provide technical assistance, conduct professional and non-professional education training and workshops, and serve as reference specialists. Brochures, articles, journals, and other literature accessible through the database search service. English and Spanish speaking information specialists are available. All resource center services are free of charge. __________________ Tuberculosis and HIV/AIDS 1995 Annotated bibliography # 12, 45-pages of references for the period January 1987 to April 1995. Health Care for the Homeless Information Resource Center (HCHIRC); Questions to Yvonne Wallace, Librarian, HCHIRC. Order from John Snow, Inc.. __________________ Tuberculosis: A Resource Kit This resource kit provides current materials on tuberculosis (TB) to clinicians and other staff caring for high risk populations. Document is divided into 11-sections: using the kit, surveillance and epidemiology, diagnosis, patient management, infection control, screening and preventive therapy, treatment of susceptible TB, multidrug-resistant TB, HIV/AIDS and TB, health education materials and organizations. Each section includes an annotated bibliography detailing current literature. Additional materials include Fact Sheets summarizing key information from the literature and selected articles and publications. John Snow, Inc. (JSI) under contract to Health Resources & Services Administration (HRSA's) Bureau of Primary Health Care. Order from JSI, note account # 1569 on check; $25.00. Send to the attention of Yvonne Wallace - Library, JSI/HCHIRC. _________________ ATTACHMENT A: Smoke Trail Test for Negative Pressure Isolation Rooms. January 14, 1994 MEMORANDUM FOR: Regional Administrators ATTENTION: ARA/Technical Support THROUGH: Leo Carey Director Office of Field Programs FROM: Patricia K. Clark Director Directorate of Technical Support SUBJECT: Smoke-trail Test for Negative Pressure Isolation Rooms The attached smoke-trail test procedure for negative pressure isolation rooms was drafted to answer questions raised by the Tarrytown AO during a recent inspection at a health-care facility. This procedure may be useful to other OSHA Compliance Officers performing inspections related to occupational exposure to Tuberculosis. This procedure will be discussed during the next teleconference on January 27, 1993. SMOKE-TRAIL TESTING METHOD FOR NEGATIVE PRESSURE ISOLATION ROOM The OSHA TB Memorandum of October 8, 1993 provides clarification for OSHA-wide enforcement policy and procedures for inspections concerning occupational exposure to TB. The OSHA TB Memorandum outlines OSHA's expectations that employers follow the principles of TB control published in the CDC document "Guidelines for Preventing the Transmission of Tuberculosis in Health-care Settings, with Special Focus on HIV-Related Issues (December 1990 MMWR)". The CDC Guidelines recommend that the TB isolation room be under negative pressure compared to surrounding spaces such that it induces airflow into the room to prevent TB contaminant from escaping the room. The CDC publication also recommends employing smoke or flutter strips to prove direction of airflow. The CDC is recommending the use of qualitative methods for demonstrating the performance of negative pressure isolation rooms rather than quantitative methods such as measuring supply/exhaust volumetric flow differentials, measuring space pressurization differentials or measuring velocity of airflow at openings into the isolation room. The employer may choose to perform quantitative tests in order to characterize and track the dynamic performance of these negative pressure isolation rooms. OSHA's expectations of conformance to the CDC Guidelines can be adequately demonstrated by qualitative testing such as smoke-trails without expending the employer's and OSHA's resources on more complex quantitative testing. The message here is to "keep it simple". TEST METHOD DESCRIPTION: One of the purposes of a negative pressure TB isolation room is to prevent TB contaminant from escaping the isolation room and entering the corridor or other surrounding uncontaminated spaces. To check for room negative pressure, use smoke-trails to demonstrate that the pressure differential is inducing airflow from the corridor, through the crack at the bottom of the door (undercut) and into the isolation room. When performing a smoke-trail test follow these recommendations where applicable: 1. Test only with the isolation room door shut. If not equipped with an anteroom, it is assumed that there will be a loss of space pressure control when the isolation room door is opened and closed. It is not necessary to demonstrate direction of airflow when the door is open. 2. If there is an anteroom, release smoke at the inner door undercut, with both anteroom doors shut. 3. In addition to a pedestrian entry, some isolation rooms are also accessed through a wider wheeled-bed stretcher door. Release smoke at all door entrances to isolation rooms. 4. So that the smoke is not blown into the isolation room, hold the smoke bottle/tube parallel to the door so the smoke is released perpendicular to the direction of airflow through the door undercut. 5. Position the smoke bottle/tube tight to the floor, centered in the middle of the door jamb and approximately two inches out in front of the door. 6. Release a puff of smoke and observe the resulting direction of airflow. Repeat the test at least once or until consistent results are obtained. 7. Minimize momentum imparted to the smoke by squeezing the bulb or bottle slowly. This will also help minimize the volume of smoke released. 8. Depending on the velocity of the air through the door undercut, the smoke plume will either stay disorganized or it will form a distinct streamline. In either case, the smoke will directionally behave in one of three ways. It will: (1) go through the door undercut into the isolation room, (2) remain motionless or (3) be blown back into the corridor. Obviously, compliance with the intent of the CDC Guidelines for negative pressure requires that the smoke be drawn into the isolation room through the door undercut. Supply air diffusers in the ceiling or upper sidewall of the corridor may throw air directly at the isolation room door and disrupt the test. If the room is unoccupied, proceed to step nine and release smoke on the inside of the door. 9. Release smoke from the corridor side of the door only for occupied TB isolation rooms. CSHOs should not enter occupied isolation rooms per the OSHA TB Memorandum of October 8, 1993. If the room is unoccupied, also release smoke inside the isolation room (same position as step 5) to verify that released smoke remains contained in the isolation room (i.e. smoke as surrogate for TB contaminant). 10. If photography or videotaping is performed, it is recommended that a dark surface be placed on the floor to maximize contrast. Be aware that most autofocusing cameras cannot focus on smoke. TESTING "AS-USED" CONDITIONS: Testing of negative pressure isolation rooms requires that the test reflect "as-used" conditions. Consider the following use variables which may affect space pressurization and the performance of the negative pressure isolation room: 1. Patient toilet rooms (TR) are mechanically exhausted to control odors. The position of the toilet room door may affect the pressure differential between the isolation room and the corridor. Smoke-trail tests should be performed with the TR door open and the TR door closed. This will not be necessary if the TR door is normally closed and controlled to that position by a mechanical door closer. 2. An open window will adversely affect the performance of a negative pressure isolation room. If the isolation room is equipped with operable windows, perform smoke-trail tests with the window open and the window closed. 3. There may be corridor doors that isolate the respiratory ward or wing from the rest of the facility. These corridor doors are provided in the initial design to facilitate space pressurization schemes and/or building life-safety codes. Direct communication with the rest of the facility may cause pressure transients in the corridor (e.g., proximity to elevator lobby) and affect the performance of the isolation room. Perform isolation room smoke-trail testing with these corridor doors in their "as-used" position which is either normally open or normally closed. 4. Isolation rooms may be equipped with auxiliary, fan-powered, recirculating, stand-alone HEPA filtration of UV units. These units must be running when the smoke-trail test is performed. 5. Do not restrict corridor foot traffic while performing smoke-trail tests. 6. Negative pressure is accomplished by exhausting more air than is supplied to the isolation room. Some HVAC systems employ variable air volume (VAV) supply air and sometimes VAV exhaust air. By varying the supply air delivered to the space to satisfy thermal requirements, these VAV systems can adversely impact the performance of a negative pressure isolation room. If the isolation room or the corridor is served by a VAV system you should perform the smoke test twice. Perform the smoke test with the zone thermostat thermally satisfied and again with the zone thermostat thermally unsatisfied thus stimulating the full volumetric flowrate range of the VAV system serving the area being tested. SMOKE: Most smoke tubes, bottles and sticks use titanium chloride (TiCl(4)) to produce visible fume. There is no OSHA PEL or ACGIH TLV for this chemical although it is a recognized inhalation irritant. Health-care professionals are concerned about releasing TiCl(4) around pulmonary patients. The smoke released at the door undercut makes only one pass through the isolation room and is exhausted directly outside. Isolation room air is typically not recirculated. As an alternative to TiCl(4), the literature suggests the use of "dry-ice" in water. Any product that is employed should be tested to insure sufficient opacity for videotaping and photography. Be prepared to present to the employer the Material Safety Data Sheet (MSDS) for the smoke that you intend to release. CSHO PROTECTION: 1. The CSHO should be familiar with the MSDS for the smoke. If TiCl(4) is used, the CSHO should avoid direct inhalation of the smoke or skin contact with the liquid. 2. The CSHO should follow the recommendations in the OSHA TB Memorandum of October 8, 1993. 3. If an isolation room is occupied by a patient infectious or suspect with TB, then the CSHO performing the smoke-trail test shall use a respirator. You should assume that the isolation room is not under negative pressure. Recent surveys (Infect Control Hosp Epidemiol 1993; 14:623-628) indicate that almost half of the isolation rooms tested were not under negative pressure. II ___________________________________________________________________________ TRAINING PROGRAMS AND MATERIALS ________________ Training Programs and Materials consist of those resources which can assist in the successful development and implementation of a tuberculosis (TB) control and prevention program. Included are self-directed studies, videos, slides, and lecture-format courses of varying duration. These resources are generally aimed at personnel who are responsible for the health and safety program or the TB control program of an organization. However, many are appropriate for workers who are, themselves, at risk. ___________________________________________________________________________ _____________________________________________________________________________ TRAINING PROGRAMS and MATERIALS _________________________________ Core Curriculum on Tuberculosis, 3rd Edition 1994 For providers of health care services providers. A 95-page training guide on clinical and public health aspects of tuberculosis control. A set of 82 slides are available to accompany the training guide, or may be ordered separately. Available at no charge from the CDC, Information Services. __________________ HHS-PHS-Federal Occupational Health - Tuberculosis Training Programs 1995 A 2-volume tuberculosis (TB) education/training program marketed to federal agencies; available on an interagency agreement basis with Federal Occupational Health (FOH). Program utilizes the CDC Core Curriculum and can be customized for the agency receiving the training. Cost is negotiated on an interagency contract basis. Tuberculosis Orientation: A Self-Study Guide for FOH Professionals > Updates the latest information from the CDC > Reviews importance of patient history > Reviews rationale and procedure for 2-step testing FOH Presents Tuberculosis in the Workplace > Orients participants to signs/symptoms of TB > Reviews screening process > Reviews importance of diagnostic follow-up > Reviews CDC treatment guidelines Contact: Peggy Coleman, RN, MS, Occupational Health Nurse Consultant to FOH, 4350 East-West Highway, Bethesda, Maryland; (301)594-0260. __________________ Mantoux Tuberculin Skin Testing Video tape, wall chart. Visual aids for training in the administration and interpretation of the Mantoux PPD Tuberculin Skin Test. Available at no charge from the CDC, Information Services. __________________ Mantoux Skin Test Pretest/Posttest 1990 12-questions relating to the Mantoux skin test. Answer key and explanations on a separate sheet. Designed to be used with the Mantoux Skin Test Instructional Video developed by the CDC; however, may be used without the video. New Hampshire Division of Public Health Services. __________________ National Tuberculosis Model Centers 3 national model center sites (San Francisco, New York City, and Newark, NJ) are funded by the Division of Tuberculosis (TB) Elimination, Centers for Disease Control and Prevention. These centers provide training courses, offer clinical consultation for difficult cases, provide epidemiologic consultation, and have access to an extensive library of both written and video materials pertaining to TB, including translated materials. Training courses include: > Preventing Tuberculosis in the Workplace - 8-hour course covering environmental and behavioral changes necessary to minimize potential for transmission of M. tuberculosis in clinical, institutional and workplace settings, including the implementation of OSHA regulations. > Tuberculosis Update - 4 to 8-hour class. Content may include epidemiology, diagnosis, management and treatment, multiple drug resistance, managing difficult cases, reporting, infection control, community control, TB and HIV. > Tuberculosis 101 - 1 to 3-day course for non-medical health workers. Content includes epidemiology, transmission, pathogenesis, screening, prevention, diagnosis, treatment, infection control. Appropriate for health outreach workers, social service agency staff, drug treatment facility workers, HIV counseling center staff. > Tuberculosis and the Law - 1 & 1/2-day course. Content includes transmission and pathogenesis, legal aspects of TB control, and infection control. > Tuberculosis Program Manager's Course - 4-day intensive course for administrative and health care personnel involved in TB program administration. See address for the "National TB Model Centers", Appendix A. __________________ Postgraduate Courses on Clinical Management and Control of Tuberculosis Intensive, 5-day courses aimed at health care professionals. The purpose of these courses is to present current scientific knowledge about tuberculosis (TB), its prevention and control to health care professionals who are responsible for the management and control of TB. Course content relevant to occupational management of TB includes factors influencing infectiousness of TB, advances in tuberculin testing, immunization, and planning TB control programs. National Jewish Center for Immunology and Respiratory Medicine. __________________ Self-Study Modules on Tuberculosis 1995 A set of 5 self-guided learning modules for health care staff and health and safety workers who are relatively new to tuberculosis (TB) control and with entry level knowledge of TB control issues. Aimed at staff/workers in high-risk facilities. Modules include: 1. Transmission and Pathogenesis 2. Epidemiology 3. Diagnosis of TB Infection and Disease 4. Treatment of TB Infection and Disease 5. Infectiousness and Infection Control Centers for Disease Control and Prevention, Tuberculosis Division. __________________ Tuberculosis: Identification, Prevention and Control 1994 Computer assisted instruction program aimed at licensed health care professionals. Thoroughly covers CDC and OSHA guidelines. Includes learning objectives and a post-test. Appropriate for facility awarded continuing education. Program can be modified to include site-specific information. Developed and written by APIC. Available from Healthsoft, Inc., PO Box 3069, Orlando, Florida 32802-9773; (800) 235-0882. Preview disk available at no charge. __________________ Tuberculosis in the Workplace: A Workbook for Working People 1994 A self-guided workbook, 103-pages, $3.00. A 24-minute video, entitled "Droplets of Death" ($15.00), is available to accompany the workbook. The Labor Institute. __________________ III _____________________________________________________________________________ WORKER EDUCATION MATERIALS AND RESOURCES ____________ The following agencies and organizations produce educational and informational materials for distribution to workers in a variety of occupational settings. While all states provide tuberculosis educational materials, those listed here may not be widely known or distributed, and may be of additional value to a particular workplace or program. The list is not exhaustive. A basic reading ability is required for the worker educational materials. Materials focused toward health care professionals are more technically challenging for the reader. All materials are in English unless otherwise noted. Appendix A provides the contact information for the cited resources. The reader will note in the cited resources that several sources do not have documents listed. The available documents were too extensive to be listed in-total in this publication. It is recommended the user of this guide contact the source for a complete listing of the available documents. ___________________________________________________________________________ _______________________________________ WORKER EDUCATION MATERIALS / RESOURCES _______________________________________ A. GENERAL INFORMATION [Includes materials aimed at worker populations identified as high risk for tuberculosis (TB) exposure.] American Federation of State, County and Municipal Employees (AFSCME) * Tuberculosis. Fact sheet. * TB in Correctional Institutions. Fact sheet. * Tuberculosis Questions and Answers. Fact sheet. * Multidrug-Resistant TB (MDR TB). Fact sheet. * OSHA Enforcement Policy & Procedures for Occupational Exposure to Tuberculosis. Checklist. American Federation of Teachers (AFT) * Tuberculosis - The "New" Epidemic. Fact sheet. American Jail Association * Jail Operations Training Bulletin on Tuberculosis. American Lung Association (ALA) * Tuberculosis Education Resource Guide. (1993). An extensive listing of patient/public educational materials, many of which are appropriate for worker education and training, both written and audio-visual. Each citation notes the intended audience, the languages the materials are available in, and the cost. Contact local chapters by calling (800) LUNG-USA (800-586-4872). American Nurses Association (ANA) * Tuberculosis: A Deadly Disease Makes a Comeback. (1993). Pamphlet. Association for Practitioners in Infection Control and Epidemiology, Inc. (APIC) * Tuberculosis: Identification, Prevention and Control. (1994). Computer assisted instruction (CAI) program aimed at licensed health care professionals. Thoroughly covers CDC and OSHA guidelines. Includes learning objectives and a post-test. Appropriate for facility awarded continuing education. Program can be modified to include site-specific information. Available from Healthsoft, Inc., PO Box 3069, Orlando, Florida, 32802-9773; (800) 235-0882. Preview disk available at no charge. * TB: What You Need To Know. (1994). Computer assisted instruction (CAI) program for non-clinical workers. Program can be modified to include site-specific information. Available at a basic reading level in English and Spanish. 30-minutes or less to complete the post test. Available from Healthsoft, Inc., PO Box 3069, Orlando, Florida, 32802-9773; (800) 235-0992. Preview disk available at no charge. * Tuberculosis: Protection For Healthcare Workers. (1995). Videotape. Approximately 20-minutes. Addresses the following: increased incidence of tuberculosis, current crisis, disease process, transmission, prevention, skin testing, laboratory identification, environmental controls, treatment, personal protection, medical monitoring. Accompanied by a comprehensive packet designed to assist in the implementation of current CDC recommendations. Distributed by Lincoln Medical Education Foundation, Attn: Tuberculosis Video, 4600 Valley Road, Lincoln, Nebraska, 68510; (402) 483-4581; FAX (402) 483-4184. $225.00 APIC members, $250.00 non-members; $35.00 preview/rental applied toward purchase. Centers for Disease Control and Prevention (CDC); Information Services * TB Facts for Health Care Workers. (1993). 7-page booklet. * Think TB! (1992). Poster listing symptoms of tuberculosis (TB); also available in Spanish. * Exposure to TB. (1991). Pad of tear-off sheets designed for correctional facility inmates; also available in Spanish. * Tuberculosis - Get the Facts. (1990). 1-page pamphlet on basic facts about transmission, infection, and testing; also available in Spanish. * Stop TB! (1994). Poster describing transmission & TB pathogenesis. * Stop TB! (1994). Pad of tear-off sheets duplicating the Stop TB! poster. * Questions and Answers About TB. (1994). 16-page booklet about transmission, skin test, and treatment. Indiana State Board of Health The Labor Institute * Tuberculosis in the Workplace: A Workbook for Working People (1994). A worker-oriented training workbook (103-pages). $3.00 each; discounted prices for large orders of workbooks - contact distributor, The Apex Press, at (914) 271-6500. * Droplets of Death: TB in the Workplace. Videotape, 24-minutes; $15.00. Mississippi State Department of Health, Tuberculosis Control Branch * Homeless Person Poster. (1992). Poster, $2.00 each for 1-100. Missouri Department of Health, Bureau of Tuberculosis Control * Facts About TB as it Occurs Among Inmates in Correctional Facilities. Videotape, 2 parts, 14 minutes and 31 minutes. * Facts About TB. Videotape, 14 minutes. * Guidelines for Education of Staff/Clients of Homeless Shelters. National Institutes of Health, National Institute of Allergy and Infectious Diseases (NIH, NIAID) * Tuberculosis. (1995). Fact sheet, 8-pages. * Tuberculosis: What Health Care Workers Should Know. (1993). Pamphlet; includes graphic flow-chart to determine high-risk persons. New York Academy of Medicine * Tuberculosis, poster, several languages available. New York State, Department of Health * Pamphlets for health care workers, criminal justice workers. * Fact sheets in English and Spanish. * Question & answer sheets about tuberculosis. * Tuberculosis, poster. * When a Co-Worker Has TB: What You Need to Know About Tuberculosis in the Workplace. (1994). Video. Service Employees International Union (SEIU) * TB: The Real Deal. (1995). Fact sheet. * No One is Immune to TB: Important Facts For All Workers. (1995). Fact sheet. * Your Right to Workers' Compensation. (1995). Fact sheet. University of California, San Diego, Preventive Pulmonary Medicine * The Many Faces of TB. (1992). 15-minute video; $100.00. The U.S. Public Health Service has a tuberculosis (TB) control office in every state and can provide general information on TB. The contact information for each state's TB control office is located in Section VI - State and Territorial Health Departments, Offices of TB Control. B. SCREENING / TESTING American Federation of State, County and Municipal Employees (AFSCME) * Screening and Skin Testing. Fact sheet. American Federation of Teachers (AFT) * Tuberculosis and the Health Care Worker - Surveillance and Preventive Therapy. Fact sheet. American Lung Association of Hawaii * Fact sheet (basic). Centers for Disease Control and Prevention (CDC), Information Services * Mantoux Tuberculin Skin Testing. (1991). Videotape training aid on the administration and interpretation of the Mantoux skin test. * Mantoux Tuberculin Skin Testing. (1990). Wall chart visual aid for interpreting the results of the skin test. * The TB Skin Test. (1991). Pad of tear-off sheets designed for correctional facility inmates; also available in Spanish. Florida Department of Health and Rehabilitation Services Kentucky Department for Health Services, Tuberculosis Control Program Massachusetts Department of Health, Tuberculosis Control Program Maryland Department of Health and Mental Hygiene, Tuberculosis Control New York State Department of Health, Tuberculosis Control Program * Fact About the TB Skin Test. (1992). In English and Spanish. * Skin Testing and Classification of Tuberculosis. Fact sheet. Oakland County Health Division (Michigan) Service Employees International Union (SEIU) * TB Skin Test: What You Need to Know About Your Health. (1995). Fact sheet. Texas Department of Health Washington (State of) Department of Health, TB Control Program C. MEDICATIONS / TREATMENT American Federation of Teachers (AFT) * Multiple-Drug Resistant TB. Fact sheet. Centers for Disease Control and Prevention (CDC), Information Services * TB Can Be Cured. (1991). Pad of tear-off sheets designed for correctional facility inmates; also available in Spanish. County of Sonoma Public Health Department (California) Florida Department of Health and Rehabilitative Services, Tuberculosis Control Program Hawaii Department of Health, Tuberculosis Branch * Individual medication instruction sheets. Massachusetts Department of Public Health, Tuberculosis Control Program * Pamphlets on isoniazid, ethambutol, pyrazinamide, rifampin, streptomycin. Montgomery County Health Department (Maryland) New York State Department of Health, Tuberculosis Control Program North Carolina Department of Environment, Health, and Natural Resources Oakland County Health Division (Michigan) * Pamphlet on positive reactors who may or may not need INH. Pennsylvania Department of Health, Tuberculosis Control Program * Pamphlets on streptomycin, rifampin, pyrazinamide, isoniazid, and ethambutol. South Dakota Lung Association Spokane County Health District (Washington state) Washington (State of), Department of Health * Pills Prevent TB. (1994). Pamphlet; available in several languages. Whatcom County Health Department (Washington state) Wisconsin Department of Health and Human Services, Tuberculosis Control Program * Pamphlets and drug information sheets on rifampin, pyrazinamide, isoniazid, and ethambutol. D. PREVENTION / CONTROL American Federation of State, County and Municipal Employees (AFSCME) * Controlling Transmission in High Risk Settings. Fact sheet. * Respiratory Protection. Fact sheet. American Federation of Teachers (AFT) * TB: Steps for Protecting Staff and Students. Fact sheet. * Tuberculosis and the Health Care Worker - Surveillance and Preventive Therapy. Fact sheet. * Tuberculosis and the Health Care Worker - Control Measures Against Exposure. Fact sheet. * TB: Steps for Protecting Workers from Workplace Exposure. Fact sheet. American Journal of Nursing (AJN) * TB or Not TB: New Guidelines for Prevention and Treatment. (1995). 19-minute video aimed at health care workers; $285.00 to purchase; $70.00 rental. Approved for CE credit. Centers for Disease Control and Prevention (CDC), Information Services * TB in Correctional Facilities. (1992). Set of 67 slides on prevention and control of tuberculosis in correctional settings; 67-page booklet of slide facsimiles based on slide set; 18-page narrative text designed to accompany slide set. * You Can Prevent TB. (1991). Pad of tear-off sheets designed for correctional facility inmates; also available in Spanish. New York State Department of Health, Tuberculosis Control Program * Preventive Therapy for Tuberculosis. Fact Sheet. Service Employees International Union (SEIU) * A Workplace TB Plan: Putting the Pieces Together. (1995). Fact sheet. * Union Tools that Work. (1995). Fact sheet. E. TB / HIV American Federation of State, County and Municipal Employees (AFSCME) * The TB/HIV Connection. Fact sheet. American Lung Association (ALA) Centers for Disease Control and Prevention (CDC); Information Services * TB and HIV (The AIDS Virus). (1991). Pad of tear-off sheets designed for correctional facility inmates; also available in Spanish. * TB/HIV Double Trouble. (1992). Poster. * TB/HIV - The Connection: What Health Care Workers Should Know. (1993). 16-page booklet. * Tuberculosis - The Connection Between TB and HIV (the AIDS Virus). (1990). 1-page pamphlet on the risk of HIV-related TB, testing, and therapy; also available in Spanish. CDC National AIDS Clearinghouse Hawaii (State of), Department of Health, AIDS/STD Project Maryland Department of Health and Mental Hygiene National Institutes of Health, National Institute of Allergy and Infectious Diseases (NIH, NIAID) * HIV-Related TB: How to Help Yourself. (1993). 8-page booklet. National Leadership Coalition on AIDS New York State Department of Health, Tuberculosis Control Program North Carolina Department of Environment, Health and Natural Resources IV _________________________________________________________________________ NON-ENGLISH LANGUAGE RESOURCES _________ Tuberculosis (TB) educational and informational materials are available for workers whose primary language is not English. These materials include general information on TB, its prevention, and treatment medications. The addresses or other contact information for the organizations cited are located in Appendix A. ____________________________________________________________________________ ______________________________ NON-ENGLISH LANGUAGE RESOURCES ______________________________ OFFICE OF MINORITY HEALTH RESOURCE CENTER (OMH-RC) Assists in locating educational and other literature and publications in languages other than English through computerized database searches. A group of publications is also available from OMH-RC which lists organizations and programs that provide minority health materials. OMH-RC services are free. AMHERIC Fairfax County (Virginia) Health Department ARABIC Francis J. Curry, National Tuberculosis Model Center ASIAN LANGUAGE LIST OF RECOMMENDED TUBERCULOSIS HEALTH EDUCATION MATERIALS Association of Asian Pacific Community Health Organization (AAPCHO) provides a list of tuberculosis educational materials and their sources which have been evaluated and approved for linguistic accuracy, cultural appropriateness, and clinical accuracy in Chinese, Korean, Tagalog, and Vietnamese. The 3-page list is in English and is continually being updated. No charge. CAMBODIAN American Lung Association of Maryland American Lung Association of San Diego and Imperial Counties (California) American Lung Association of Virginia Fairfax County (Virginia) Health Department Francis J. Curry, National Tuberculosis Model Center Hawaii State Department of Health Maryland Department of Health and Mental Hygiene, Tuberculosis Control Massachusetts Department of Public Health, TB Control Program Massachusetts Refugee Health Program Seattle-King County Department of Public Health (Washington state) Sonoma County TB Control Chest Clinic (California) State of Hawaii, AIDS/STD Project Washington (state) Department of Health, Tuberculosis Control CAPE VERDEAN Massachusetts Department of Public Health, Tuberculosis Control Program CHINESE American Lung Association of Alameda County (California) American Lung Association of Hawaii American Lung Association of Los Angeles County (California) American Lung Association of Maryland American Lung Association of San Francisco American Lung Association of Virginia Asian Health Services Association of Asian Pacific Community Health Organizations California Department of Health Services Francis J. Curry, National Tuberculosis Model Center Massachusetts Department of Public Health, Tuberculosis Control Program North East Medical Services (NEMS) San Francisco Department of Public Health, Division of TB Control Seattle-King County Department of Public Health, Tuberculosis Division (Washington state) Sonoma County TB Control Chest Clinic (California) State of Hawaii, AIDS/STD Project The New York Academy of Medicine CANTONESE CHINESE American Lung Association of San Francisco San Francisco Department of Public Health, Division of TB Control CREOLE (HAITIAN) American Lung Association of Virginia Dade County Public Health Unit, Tuberculosis Control Program (Florida) Massachusetts Department of Public Health, Tuberculosis Control Program The New York Academy of Medicine DARI American Lung Association of Virginia ETHIOPIAN (Tigrinia) American Lung Association of Virginia Fairfax County Health Department (Virginia) Francis J. Curry, National Tuberculosis Model Center Sonoma County TB Control Chest Clinic (California) FARSI American Lung Association of Virginia Fairfax County Health Department (Virginia) FILIPINO (TAGALOG) American Lung Association of Hawaii American Lung Association of Virginia Asian Health Services Association of Asian Pacific Community Health Organizations California Department of Health Services Francis J. Curry, National Tuberculosis Model Center State of Hawaii, AIDS/STD Project FRENCH American Public Health Association Massachusetts Department of Public Health, Tuberculosis Control Program New York City Health Department, Bureau of Tuberculosis GREEK Massachusetts Department of Public Health, Tuberculosis Control Program HMONG American Lung Association of Hawaii ILOCANO American Lung Association of Hawaii Association of Asian Pacific Community Health Organizations Hawaii State Department of Health State of Hawaii, AIDS/STD Project ITALIAN American Public Health Association Massachusetts Department of Public Health, Tuberculosis Control Program JAPANESE American Lung Association of Hawaii Spokane County Health District (Washington state) State of Hawaii, AIDS/STD Project Washington (state) Department of Health, Tuberculosis Control Program KOREAN American Lung Association of Hawaii American Lung Association of Los Angeles County American Lung Association of Virginia Asian Health Services Association of Asian Pacific Community Health Organizations California Department of Health Services Fairfax County Health Department (Virginia) Francis J. Curry, National Tuberculosis Model Center Hawaii State Department of Health Los Angeles County Health Department Louisville and Jefferson County Board of Health (Kentucky) Madigan Army Hospital Medical Center (Washington state) Seattle-King County Department of Public Health, Tuberculosis Division (Washington state) State of Hawaii, AIDS/STD Project Washington (state) Department of Health, Tuberculosis Control Program LAOTIAN American Lung Association of Hawaii American Lung Association of Los Angeles American Lung Association of Maryland American Lung Association of San Diego and Imperial Counties (California) American Lung Association of Virginia Fairfax County Health District (Virginia) Francis J. Curry, National Tuberculosis Model Center Hawaii State Department of Health Louisville and Jefferson County Board of Health (Kentucky) Maryland Department of Health and Mental Hygiene, Tuberculosis Control Massachusetts Department of Public Health, TB Control Program Massachusetts Refugee Health Program Seattle-King County Department of Public Health, Tuberculosis Division (Washington state) Sonoma County TB Control Chest Clinic (California) Spokane County Health District (Washington state) State of Hawaii, AIDS/STD Project Washington (state) Department of Health, Tuberculosis Control Program POLISH Washington (state) Department of Health, Tuberculosis Control Program PORTUGUESE Massachusetts Department of Public Health, Tuberculosis Control Program ROMANIAN Sonoma County TB Control Chest Clinic (California) RUSSIAN American Lung Association American Lung Association of Massachusetts Dupage County Health Department, Tuberculosis Clinic (Illinois) Francis J. Curry, National Tuberculosis Model Center Massachusetts Department of Public Health Washington (state) Department of Health, Tuberculosis Control Program SAMOAN American Lung Association of Hawaii Hawaii State Department of Health State of Hawaii, AIDS/STD Project SAUDI Spokane County Health District (Washington state) SPANISH American Academy of Pediatrics-Committee on Infectious Diseases American Lung Association American Lung Association of Brooklyn (New York) American Lung Association of Los Angeles County American Lung Association of Massachusetts American Lung Association of San Francisco American Public Health Association Centers for Disease Control and Prevention, Division of Tuberculosis Elimination Chelan-Douglas Health District (Washington state) County of Los Angeles Department of Health Services, Tuberculosis Control (California) County of Los Angeles, Health Education Unit (California) Dade County Public Health Unit, Tuberculosis Control Program (Florida) Fairfax County Health Department (Virginia) Florida Department of Health and Rehabilitative Services, Tuberculosis Control Program Francis J. Curry, National Tuberculosis Model Center Louisville and Jefferson County Board of Health (Kentucky) Madigan Army Hospital Medical Center (Washington state) Malheur County Health Department (Oregon) Massachusetts Department of Public Health, Tuberculosis Control Program Montgomery County Health Department (Maryland) New Hampshire Division of Public Health Services New Mexico, Health and Environment Department, TB Control Program New York City Health Department, Bureau of Tuberculosis Orange County Health Care Agency (California) Prince George's County TB Control Division (Maryland) San Francisco Department of Public Health, Division of TB Control Seattle-King County Department of Public Health, Tuberculosis Division (Washington state) Skagit County Health Department (Washington state) Sonoma County TB Control Chest Clinic (California) Spokane County Health District (Washington state) Texas Department of Health, Tuberculosis Control Division The New York Academy of Medicine US-Mexico Border Health Association (JUNTOS Project) Wake County Department of Health (North Carolina) Washington (state) Department of Health, Tuberculosis Control Program THAI State of Hawaii, AIDS/STD Project TONGAN Hawaii State Department of Health, Tuberculosis Branch State of Hawaii, AIDS/STD Project VIETNAMESE American Lung Association of Hawaii American Lung Association of San Diego and Imperial Counties (California) American Lung Association of Virginia Asian Health Services Association of Asian Pacific Community Health Organizations California Department of Health Services Fairfax County Health Department (Virginia) Francis J. Curry, National Tuberculosis Model Center Louisville and Jefferson County Board of Health (Kentucky) Maryland Department of Health and Mental Hygiene, Tuberculosis Control Massachusetts Department of Public Health, TB Control Program Massachusetts Refugee Health Program Montgomery County Health Department (Maryland) Orange County Health Care Agency (California) Prince George's County TB Control Division (Maryland) Seattle-King County Department of Public Health, Tuberculosis Division (Washington state) Sonoma County TB Control Chest Clinic (California) Spokane County Health District (Washington state) State of Hawaii, AIDS/STD Project Washington (state) Department of Health, Tuberculosis Control Program VISAYAN State of Hawaii, AIDS/STD Project V __________________________________________________________________________ PUBLICATIONS AND RESOURCES FOR CLINICIANS _____________ This section, Publications and Resources for Clinicians, contains resources for health care providers who are delivering care to persons with tuberculosis. The materials are highly technical and clinically-oriented. The addresses and other contact information for the organizations cited are located in Appendix A. ____________________________________________________________________________ _________________________________________ PUBLICATIONS and RESOURCES for Clinicians _________________________________________ American Association of Occupational Health Nurses. (1994). AAOHN advisory: Tuberculosis. AAOHN Journal, 42(10). Reprints from AAOHN: $5.00 members; $8.00 non-members. American Thoracic Society. (1990). Diagnostic standards and classification of tuberculosis. American Review of Respiratory Disease, 142, 725-735. Association of Asian Pacific Community Health Organizations. (1994). Clinical TB protocol. Available at no charge from AAPCHO. Association of State & Territorial Public Health Laboratory Directors; and, Public Health Practice Program Office, Division of Laboratory Systems (CDC). (1995). Mycobacterium tuberculosis: Assessing your laboratory, (ASTPHLD #U60-CCU303019). Atlanta, GA: CDC Carmon, M. (1993). Legal challenges of tuberculosis in the workplace. AAOHN Journal, 41(2), 96-100. Centers for Disease Control and Prevention. (1994). Expanded tuberculosis surveillance and tuberculosis morbidity - United States, 1993. Morbidity and Mortality Weekly Report, 43(20), 361-366. Centers for Disease Control and Prevention. (1993). Initial therapy for tuberculosis in the era of multi-drug resistance: Recommendations of the advisory council for the elimination of tuberculosis (ACET). Morbidity and Mortality Weekly Report, 42(No. RR-7). Centers for Disease Control and Prevention. (1991). Purified protein derivative (PPD)-tuberculin anergy and HIV infection: Guidelines for anergy testing and management of anergic persons at risk of tuberculosis. Morbidity and Mortality Weekly Report, 40(No. RR-5). Centers for Disease Control and Prevention. (1993). Technical guidance on HIV counseling. Morbidity and Mortality Weekly Report, 42(No. RR-2). Colditz, G.A., Brewer, T.F., Berkey, C.S., Wilson, M.E. Burdick, E., Fineberg, H.V., & Mosteller, F. (1994). Efficacy of BCG vaccine in the prevention of tuberculosis: Meta-analysis of the published literature. JAMA, 271(9), 698-702. Daugherty, J.S., Hutton, M.D., & Simone, P.M. (1993). Prevention and control of tuberculosis in the 1990s. Nursing Clinics of North America, 28(3), 599-611. Directly observed therapy (DOT): It can help you cure TB. Informational brochure for physicians to introduce them to the benefits of DOT. Available from New York State Department of Health. Huebner, R.E., Schein, M.F., & Bass, J.B., Jr. (1993). The tuberculin skin test. Clinical Infectious Diseases, 17, 968-975. National AIDS Clearinghouse (CDC). (1995). HIV/AIDS and tuberculosis. A database search drawn from the CDC National Clearinghouse's Educational Materials Database. The database is updated twice yearly. National Institutes of Health, National Institute of Allergy and Infectious Diseases. (1993). Tuberculosis: Resurgence of an old problem. Office of Minority Health Resource Center (OMH-RC) Resource and referral service. Offers database searches, information exchange, publications, mailing lists, technical assistance, data and statistics, and referrals. Resource Person Network (volunteers) available to provide technical assistance, conduct professional level education training and workshops, and serve as reference specialists. Database searches to locate brochures, articles, bibliographies, journals, and other literature. All resource center services are free of charge. The following resources are available at no charge from the Centers for Disease Control & Prevention (CDC), Information Services (IS). The address for IS, National Center for Prevention Services, at the CDC is listed in Appendix A. In addition, a reproducible order form for CDC material is located in Appendix B. American Thoracic Society. (1992). Control of tuberculosis in the United States. American Review of Respiratory Disease, 146(6), 1623-1633. American Thoracic Society. (1994). Treatment of tuberculosis and tuberculosis infection in adults and children. American Journal of Respiratory and Critical Care Medicine, 149(5), 1359-1374. Centers for Disease Control and Prevention. (1990). Screening for tuberculosis and tuberculosis infection in high-risk populations and use of preventive therapy for tuberculosis infection in the US. Morbidity and Mortality Weekly Report, March 18. Centers for Disease Control and Prevention. (1993). Tuberculosis control laws - United States, 1993: Recommendations of the advisory council for the elimination of tuberculosis (ACET). Morbidity and Mortality Weekly Report, 42,(No. RR-15), November 12. Centers for Disease Control and Prevention. (1992). Management of persons exposed to multidrug-resistant tuberculosis. Morbidity and Mortality Weekly Report, 41(No. RR-11), June 19. Core curriculum on tuberculosis, 3rd Edition. (1994). For providers of health care services. A 95-page training guide on clinical and public health aspects of tuberculosis control. A set of 82 slides to accompany the training booklet is also available. Reported tuberculosis in the United States, 1993. Statistics on tuberculosis cases and case rates reported for 1993. TB care guide: Highlights from core curriculum on tuberculosis. (1994). A 57-page booklet for clinicians on care of TB patients, with a tear-off card for dosage calculation and reference. Treating tuberculosis: A clinical guide. (1994). A fold-out chart with 8 panels with tables on TB treatment and medications for clinicians' reference. VI __________________________________________________________________________ STATE AND TERRITORIAL OFFICES OF TUBERCULOSIS CONTROL __________ Each state and territory of the United States has an Office of Tuberculosis Control. The point of contact for each office listed is current as of May 1995. Your local telephone directory should be consulted for any number or personnel changes. ____________________________________________________________________________ STATE AND TERRITORIAL HEALTH DEPARTMENTS Tuberculosis Control Offices ____________________________________________________________________________ Frank K. Bruce | William W. Stead, MD Director | Director Tuberculosis Control Branch | Tuberculosis Control Division Alabama Department of Public Health| Arkansas Department of Health 434 Monroe Street | 4815 West Markham Street Montgomery, ALABAMA 36130-3017 | - Mailstop 45 | Little Rock, ARKANSAS 72205 | Consultant: N/A | Consultant: Dory Moers, RN | Phone: (334) 613-5330 | Phone: (501) 661-2398 Fax: (334) 288-5021 | Fax: (501) 661-2759 ___________________________________|________________________________________ | Elizabeth Funk, MD | Sarah Royce, MD, MPH Epidemiologist | Chief Infectious Disease Group | TB Control Branch Alaska Health Department and | California Department of Social Services | Health Services Section of Epidemiology | 2151 Berkeley Way, Room 715 P.O. Box 240249 | Berkeley, CALIFORNIA 94704-1101 Anchorage, ALASKA 99524 | | Consultant: Suzanne Banda, RN | Consultant: N/A | Phone: (907) 561-4406 | Phone: (510) 540-2973 Fax: (907) 562-7802 | Fax: (510) 849-5269 ___________________________________|________________________________________ | Edgar Reed, MD | Richard E. Hoffman, MD, MPH Department of Health | Tuberculosis Control Officer Government of American Samoa | Colorado Department of Health LBJ Tropical Medical Center | 4300 Cherry Creek Drive South Pago Pago, AMERICAN SAMOA 96799 | DCEED-A3 | Denver, COLORADO 80222-1530 | Consultant: N/A | Consultant: N/A | Phone: 9-011-684-633-2243 | Phone: (303) 692-2676 Fax: 9-011-684-633-5379 | Fax: (303) 782-0904 ___________________________________|________________________________________ | Norman J. Petersen, FM | Joseph Marino Acting Assistant Director | Program Director Disease Prevention Services | TB Control Program Arizona Department of Health | Connecticut Department of Public Services | Health Services 3815 North Black Canyon Highway | 150 Washington Street Phoenix, ARIZONA 85015 | Hartford, CONNECTICUT 06106 | Consultant: Caroline Nejedlo, RN | Consultant: Patricia Kucharski, RN | Phone: (602) 230-5808 | Phone: (203) 566-3099 Fax: (602) 230-5959 | Fax: (203) 566-5823 ___________________________________|________________________________________ | Kathleen E. Russell, MPH | Beverly Devoe, MHS Coordinator | Program Manager Tuberculosis Elimination Program | Tuberculosis Control Program Delaware Dept. of Health and | Georgia Department of Social Services | Human Resources Jessie Cooper Building | 1305 Redmond Circle, Building 512 P.O. Box 637 | Rome, GEORGIA 30161-1393 Dover, DELAWARE 19903 | | Consultant: N/A | Consultant: N/A | Phone: (302) 739-6620 | Phone: (706) 295-6292 Fax: (302) 739-6617 | Fax: (706) 295-6747 ___________________________________|________________________________________ | VACANT | Cecilia T. Arciaga Chief | Tuberculosis Program Coordinator Bureau of Tuberculosis Control | Department of Public Health Department of Health and | and Social Services Human Services | Government of Guam DCGH - Building 15 | P.O. Box 2816 1905 E Street, SE | Agana, GUAM 96910 Washington, DISTRICT OF COLUMBIA | 20003 | | Consultant: Jean Mainer, RN | Consultant: N/A | Phone: (202) 724-2195 | Phone: 9-001-671-734-7145 Fax: (202) 724-2363 | Fax: 9-001-671-734-5910 ___________________________________|________________________________________ | Lerina Nena, RN | Azucena Ignacio, MD TB Program Manager | Chief Dept. of Health Services | Tuberculosis Branch P.O. Box PS70, Palikir Station | Hawaii Department of Health Palikir | 1700 Lanakila Avenue Pohnpei, FEDERATED STATES OF | Honolulu, HAWAII 96817-2199 MICRONESIA 96941 | | Consultant: N/A | Consultant: N/A | Phone: 9-011-691-320-2619 | Phone: (808) 832-5731 Fax: 9-011-670-233-0214 | Fax: (808) 832-5846 ___________________________________|________________________________________ | James Jackson | Jesse Greenblatt, MD, MPH Director, HIV/STD/TB Prevention | State Epidemiologist Florida Department of Health & | Idaho Department of Health Rehab. Services | and Welfare 1317 Winewood Blvd., Building E | 450 West State Street 4th Floor, Room 416 | Boise, IDAHO 83720 Tallahassee, FLORIDA 32399-0700 | | Consultant: N/A | Consultant: N/A | Phone: (904) 487-3684 | Phone: (208) 334-5941 Fax: (904) 487-1521 | Fax: (208) 334-6581 ___________________________________|________________________________________ | Ben Atkinson, MPH | Gene D. Simmons, MPH Chief | Program Manager TB Control Program | Tuberculosis Control Program Illinois Department of | Kentucky Department for Public Health | Health Services 525 West Jefferson Street | 275 East Main Street - 1st Floor | Frankfort, KENTUCKY 40621-001 Springfield, ILLINOIS 62761 | | Consultant: N/A | Consultant: Donna Perkins, | RN, BSN | Phone: (217) 785-5371 | Phone: (502) 564-4276 Fax: (217) 524-4515 | Fax: (502) 564-4553 ___________________________________|________________________________________ | VACANT | Vic Tomlinson Director | Tuberculosis Control Section Division of Communicable Disease | Louisiana Department of Health Indiana State Department of Health | and Hospitals P.O. Box 1964 | 325 Loyola, Room 617 1330 West Michigan Street | New Orleans, LOUISIANA 70112 Indianapolis, INDIANA 46206-1964 | | Consultant: N/A | Consultant: N/A | Phone: (317) 383-6458 | Phone: (504) 568-5015 Fax: (317) 383-6747 | Fax: (504) 568-5016 ___________________________________|________________________________________ | Patricia Quinlisk, MD | Kathy Gensheimer, MD Iowa Department of Public Health | Director, TB Control and Lucas State Office Building | Refugee Program 321 East 12th Street | Bureau of Health Des Moines, IOWA 50319-0075 | Department of Human Services | 157 Capitol - State House, | Station #11 | Augusta, MAINE 04333 | Consultant: N/A | Consultant: Joan Blossom, RN | Phone: (515) 281-4941 | Phone: (207) 287-3748 Fax: (515) 242-4958 | Fax: (207) 287-6865 ___________________________________|________________________________________ | Harold H. Geer | Sarah Bur, RN, MPH Director, TB Control Section | Chief Bureau of Disease Control | Division of Tuberculosis Control Kansas Department of Health | Maryland Dept. of Health and and Environment | Mental Hygiene 109 Southwest Ninth Street | 201 West Preston Street Mills Building, Suite 605 | O'Connor Building - 3rd Floor, Topeka, KANSAS 66612-1271 | Rm 307A | Baltimore, MARYLAND 21201-2399 | Consultant: Angela Akerstron, RN | Consultant: N/A | Phone: (913) 296-5589 | Phone: (410) 225-6692 Fax: (913) 296-4197 | Fax: (410) 669-4215 ___________________________________|________________________________________ | Sue C. Etkind, RN, MS | Mahree Skalar Director | Deputy Director Tuberculosis Control Program | Division of Environmental Health Massachusetts Department of | and Epidemiology Public Health | Missouri Department of Health 305 South Street | 1730 East Elm Street Jamaica Plain, MASSACHUSETTS 02130| P.O. Box 570 | Jefferson City, MISSOURI | 65102-0570 | Consultant: Janice Boutotte, RN | Consultant: Marty Huber, RN | Phone: (617) 983-6970 | Phone: (314) 751-6080 Fax: (617) 983-8735 | Fax: (314) 526-6892 ___________________________________|________________________________________ | Dennis Minnice | Denise Ingman Chief | TB Program Coordinator Division of Tuberculosis Control | Preventive Health Services Michigan Department of | Montana State Department of Public Health | Health and Environmental Science. P.O. Box 30035 | 1400 Broadway - Cogsweil Building 3500 N. Martin Luther King Blvd. | Helena, MONTANA 59620-0901 Lansing, MICHIGAN 48909 | | Consultant: N/A | Consultant: N/A | Phone: (517) 335-8063 | Phone: (406) 444-0275 Fax: (517) 335-8121 | Fax: (406) 444-2606 ___________________________________|________________________________________ | Kristine MacDonald, MD, MPH | Roger Murray Director, TB Control Program | Coordinator Minnesota Department of Health | Tuberculosis Control Program P.O. Box 9441 | Nebraska Department of Health 717 Delaware Street SE | 301 Centennial Mall South Minneapolis, MINNESOTA 55440 | P.O. Box 95007 | Lincoln, NEBRASKA 68509-5007 | Consultant: Claudia Miller | Consultant: N/A | Phone: (612) 623-5526 | Phone: (402) 471-2937 Fax: (612) 623-5743 | Fax: (402) 471-6426 ___________________________________|________________________________________ | James M. Holcombe, MPA | Sandra Henneke, RN Director | Program Manager Tuberculosis Control Branch | Tuberculosis Control Program Mississippi State Department | Nevada State Department of of Health | Human Resources 2423 North State Street | 505 East King Street, Room 304 Jackson, MISSISSIPPI 39216 | Carson City, NEVADA 89710 | Consultant: Paulette W. Smith, RN | Consultant: N/A | Phone: (601) 960-7700 | Phone: (702) 687-4800 Fax: (601) 354-0661 | Fax: (702) 687-4988 ___________________________________|________________________________________ | Richard DiPentima, RN, MPH | James Jones, MPH TB Program Chief | Chief, Tuberculosis Control Bureau | Section Bureau Disease Control | Dept. of Environment, Health, & New Hampshire Division of Public | Natural Resources Health Services | P.O. Box 27687 6 Hazen Drive | Raleigh, NORTH CAROLINA Concord, NEW HAMPSHIRE 03301-6527 | 27611-7687 | Consultant: Janice Oberacker | Consultant: Dee Foster, RN | Phone: (603) 271-4496 | Phone: (919) 733-7286 Fax: (603) 271-4933 | Fax: (919) 715-4699 ___________________________________|________________________________________ | Clifford G. Freund | Larry Shireley, MPH Director | TB Control Program Communicable Disease Services | Division of Disease Control New Jersey State Department | North Dakota Department of of Health | Health University Office Plaza - CN 369 | 600 East Boulevard Avenue Trenton, NEW JERSEY 08625-0369 | Bismarck, NORTH DAKOTA | 58505-0200 | Consultant: Doris Lewis, | Consultant: N/A RN, MA, MPA | | Phone: (609) 588-7539 | Phone: (701) 328-2378 Fax: (609) 588-7431 | Fax: (701) 328-4727 ___________________________________|________________________________________ | Doris Fields | Isamu J. Abraham, MO Director, Tuberculosis Control | Secretary of Health Program | Commonwealth of the Northern Bureau of Infectious Disease | Mariana Islands Prevention & Control | Department of Health Public Health Division | P.O. Box 409 CK Health and Environment Department | Saipan, MARIANA ISLANDS P.O. Box 26110 | 1990 St. Francis Drive | Santa Fe, NEW MEXICO 87502 | | Consultant: Jean Smithpeter, | Consultant: Lupe Hofschnieder RN, MSN | | Phone: (505) 827-0156 | Phone: 9-011-670-234-8950 Fax: (505) 827-0163 | Fax: 9-011-670-234-8930 ___________________________________|________________________________________ | George DiFerdinando, MD, MPH | Thomas J. Halpin, MD Director | Director Bureau TB Control | Division of Prevention Medicine New York State Department of Health| Ohio Department of Health Corning Tower, Room 840/859 | P.O. Box 118 Empire State Plaza | 246 North High Street Albany, NEW YORK 12237 | Columbus, OHIO 43266-0118 | Consultant: Elizabeth Foster, RN | Consultant: Shirley Dobbins, RN | Phone: (518) 474-7000 | Phone: (614) 466-0304 Fax: (518) 473-6164 | Fax: (614) 644-8526 ___________________________________|________________________________________ | Jon Tillinghast, MD, MPH | Mildred Soto, MPH TB Control Officer | Director Communicable Disease Division | Tuberculosis Control Program Oklahoma State Department of Health| Department of Health 1000 NE Tenth Street | P.O. Box 71423, Correo General Oklahoma City, OKLAHOMA 73117-1299| San Juan, PUERTO RICO 00936-1423 | Consultant: Helen Gretz, RN | Consultant: Millie Rodriquez, | RN, MSN | Phone: (405) 271-4063 | Phone: (809) 721-2000, x 205 Fax: (405) 271-5149 | Fax: (809) 723-3565 ___________________________________|________________________________________ | Elizabeth Brown, MS, RN | Janet O'Connel, MPH TB Program Director | Program Administrator for Oregon Health Division | TB Control 800 NE Oregon, Suite 772 | Office of Disease Control Portland, OREGON 97232 | Rhode Island Department of Health | 3 Capitol Hill | Providence, RHODE ISLAND 02908-5097 | Consultant: Liz Binam, RN | Consultant: Jean Mainer | Phone: (503) 731-4024 | Phone: (401) 277-2577 Fax: (503) 731-4798 | Fax: (401) 272-3771 ___________________________________|________________________________________ | Anthony Polloi, MD | Donald F. Capella Director | Secretary of Health and Environment ATTN: Jill McCready | P.O. Box 16 Bureau of Health Services | Majuro Hospital Republic of Palau | Majuro, REPUBLIC OF MARSHALL P.O. Box 6027 | ISLANDS 96960 Koror, PALAU - W.C. Is. 96940 | | Consultant: N/A | Consultant: Justina R. Langidrik, MPH | | Phone: 9-011-680-488-2813 | Phone: 9-011-692-625-7246 Fax: 9-011-680-488-1211 | Fax: 9-011-692-625-3432 ___________________________________|________________________________________ | VACANT | Carol J. Pozsik, RN, MPH Tuberculosis Control Program | Director Pennsylvania Department of Health | Division of Tuberculosis Control P.O. Box 90 | S. Carolina Department of Health & Health and Welfare Building | Environmental Control - 10th Floor West | 2600 Bull Street Commonwealth and Forster Street | Columbia, SOUTH CAROLINA 29201 Harrisburg, PENNSYLVANIA | 17108-0090 | | Consultant: N/A | Consultant: Betty Gore, RN, | MSN, CIC | Phone: (717) 787-6267 | Phone: (803) 737-4150 Fax: (717) 783-3794 | Fax: (803) 737-6531 ___________________________________|________________________________________ | Kristin Schweigert | William Graham, MD TB Project Coordinator | Medical Director Office of Communicable Disease | Tuberculosis Control Program Prevention and Control | Vermont Department of Health South Dakota State Department | P.O. Box 70 of Health | 109 Cherry Street 445 East Capitol Avenue | Burlington, VERMONT 05402 Pierre, SOUTH DAKOTA 57501-3182 | | Consultant: N/A | Consultant: N/A | Phone: (605) 773-3364 | Phone: (802) 863-7245 Fax: (605) 773-6623 | Fax: (802) 865-7701 ___________________________________|________________________________________ | H. David Crowder | VACANT Division of Tuberculosis Control | Bureau of Tuberculosis Control Tennessee Department of Health | Virginia State Department of Health and Environment | 1500 East Main Street, Rm. 119 Tennessee Tower Building | Richmond, VIRGINIA 23218 - 13th Floor | Nashville, TENNESSEE 37247-4911 | | Consultant: Pat Johnson, RN | Consultant: N/A | Phone: (615) 532-2691 | Phone: (804) 786-6251 Fax: (615) 532-8478 | Fax: (804) 371-0248 ___________________________________|________________________________________ | Michael F. Kelley, MD, MPH | Sylvia Buntin-Simmons, PhD Bureau Chief | Project Director Bureau of Communicable Disease | TB Control Program Control | Virgin Islands Department of Health Texas Department of Health | Community Health Services 1100 West 49th Street | 48 Sugar Estate Austin, TEXAS 78756-3199 | St Thomas Hospital | St Thomas, VIRGIN ISLANDS 00802 | Consultant: Isabel Vitek, | Consultant: N/A RN, BSN | | Phone: (512) 458-7455 | Phone: (809) 774-3168 Fax: (512) 458-7787 | Fax: (809) 771-4001 ___________________________________|________________________________________ | Lillian Tom-Orme, RN, PhD | Kay Anderson, RN Director, Community Health | TB Controller Services | Washington Department of Health Refugee and Pulmonary Program | 1511 Third Avenue, Suite 201 Utah Department of Health | Seattle, WASHINGTON 98101 P.O. Box 142868 | 288 North, 1460 West | Salt Lake City, UTAH 84114-2868 | | Consultant: Margaret Chamberlin, | Consultant: Sheryl Palaniuk, RN RN, BSN | | Phone: (801) 538-6141 | Phone: (206) 464-5327 Fax: (801) 538-6694 | Fax: (206) 464-6123 ___________________________________|________________________________________ | James H. Walker, MD | Dawn Tuckey Director | Director Tuberculosis Control Program | Tuberculosis Control Program West Virginia Department of Health | Wisconsin Department of Health 1422 East Washington Street | & Social Services Charleston, WEST VIRGINIA 25301 | 1414 East Washington Avenue | Madison, WISCONSIN 53703 | Consultant: Carolyn Winkler, RN | Consultant: N/A | Phone: (304) 558-2669 | Phone: (608) 266-9452 Fax: (304) 558-6335 | Fax: (608) 266-3696 ___________________________________|________________________________________ | Alex Bowler | Coordinator | Wyoming Department of Health | and Social Services | Hathaway Building, 4th Floor, | Room 419 | Cheyenne, WYOMING 82002 | | Consultant: N/A | | Phone: (307) 777-5658 | Fax: (307) 777-5402 | ___________________________________|________________________________________ APPENDIX A Addresses / Contact Information Addresses & Contacts for TB Resources AIDS Action Council 1875 Connecticut Ave., NW, Suite 700 Washington, DC 20009 (202) 986-1300 - FAX: (202) 986-1345 AIDS Coalition to Unleash Power ("Act-Up") 135 W. 29th Street, #10 New York, New York 10001 (212) 564-2437 - FAX (212) 594-5441 Alma Illery Medical Center 7227 Hamilton Avenue Pittsburgh, Pennsylvania 15208 (412) 244-4775 American Academy of Family Physicians 8880 Ward Parkway Kansas City, Missouri 64114 (816) 333-9700 or (800) 274-2237 (toll free) American Academy of Pediatrics 141 Northwest Point Boulevard Elk Grove Village, Illinois 60007-0927 (708) 228-5005 - FAX (708) 228-5097 American Ambulance Association 50 Monroe, NW Suite 420 Grand Rapids, MI 49503-6201 (616) 454-0775 American Association for Continuity of Care 1730 N. Lynn Street, Suite 502 Arlington, Virginia 22209 (703) 525-1191 - FAX (703) 276-8196 American Association for Respiratory Care 11030 Ables Lane Dallas, Texas 75229 (214) 243-2272 - FAX (214) 484-2720 American Association for World Health 1129 20th Street, NW, Suite 400 Washington, DC 20036 (202) 466-5883 - FAX (202) 466-5896 American Association of Occupational Health Nurses (AAOHN) 50 Lenox Pointe Atlanta, GA 30324-3176 (800) 241-8014 / (404) 262-1162 / FAX (404) 262-1165 American College of Chest Physicians 3300 Dundee Road Northbrook, Illinois 60062-2348 (708) 498-1400 - FAX (708) 498-5460 American College of Internal Physicians 711 Second Street, NE, Suite 200 Washington, DC 20002 (202) 544-7498 - FAX (202) 546-7105 American College of Physicians Independence Mall West, Sixth Street at Race Philadelphia, Pennsylvania 19106-1572 (215) 351-2829 - FAX (215) 351-2829 American College of Preventive Medicine 1015 15th Street, NW, Suite 403 Washington, DC 20005 (202) 789-0003 - FAX (202) 289-8274 American Correctional Health Services Association 11 West Monument Ave., Suite 510 P.O. Box 2307 Dayton, Ohio 45401-2307 (513) 223-9630 - FAX (513) 223-6307 American Federation of State, County and Municipal Employees, AFL-CIO (AFSCME) 1625 L Street, NW Washington, DC 20036-5687 (202) 429-1000 - FAX (202) 429-1293 American Federation of Teachers, AFL-CIO (AFT) 555 New Jersey Avenue, NW Washington, DC 20001-2079 (202) 393-5674 - FAX (202) 879-4597 American Geriatrics Society 770 Lexington Avenue, Suite 400 New York, New York 10021 (212) 308-1414 American Health Care Association (AHCA) 1201 L Street, NW Washington, DC 20005 (202) 898-2850 - FAX (202) 842-3860 American Hospital Association 1 North Franklin Street Chicago, Illinois 60606 (312) 422-3000 American Jail Association 2053 Day Road, Suite 100 Hagerstown, Maryland 21740-9795 ATTN: Training Coordinator (301) 790-3930 - FAX (301) 790-2941 American Journal of Nursing Company (AJN) Educational Services Division 555 West 57th Street New York, New York 10019-2961 (800) CALL-AJN [(800) 225-5256] - FAX (212) 944-9055 American Lung Association 1740 Broadway New York, New York 10019-4374 (212) 315-8700 - FAX (212) 265-5642 (800) LUNG-USA [(800) 586-4872] to contact local chapters or request information. American Medical Association 515 North State Street Chicago, Illinois 60610 (312) 464-5000 - FAX (312) 464-4184 American Nurses Association 600 Maryland Avenue, SW, Suite 100W Washington, DC 20024-2571 (202) 651-7126 - (800) 637-0323 American Public Health Association 1015 15th Street NW Washington, DC 20005 (202) 789-5600 - FAX (202) 789-5681 American Society for Microbiology 1325 Massachusetts Avenue, NW Washington, DC 20005 (202) 737-3600 American Thoracic Society 1740 Broadway New York, New York 10019-4374 (212) 315-8778 - FAX (212) 265-5642 Asian Health Services 310 Eighth Street Suite 200 Oakland, California 94607 (510) 465-3374 Association for Practitioners in Infection Control and Epidemiology, Inc. (APIC) 1016 16th Street, NW, 6th Floor Washington, DC 20036 (202) 296-2742 - FAX (202) 296-5645 Exec. Director: Rick Dorman Association of Asian Pacific Community Health Organizations (AAPCHO) 1212 Broadway, Suite 730 Oakland, California 94612-1825 (510) 272-9536 - FAX (510) 272-0817 Program Coordinator: Jeff Caballero Association of Community Health Nursing Educators President Bianca M. Chambers, RN, D.N.Sc. Indiana University School of Nursing Department of Community Health Nursing 1111 Middle Drive Indianapolis, Indiana 46202-5107 (317) 274-2129 - FAX (317) 278-1378 Association of State and Territorial Directors of Nursing Elfrida Nord, RN, MPH Chief, Section of Nursing Department of Health and Social Services P.O. Box 110611 Juneau, Alaska 99811-0611 (907) 465-3150 - FAX (907) 465-3913 Association for Professionals in Infection Control and Epidemiology, Inc. 1016 16th Street, NW - Sixth Floor Washington, DC 20036 (202) 296-2742 - FAX (202) 296-5645 Association of State and Territorial Health Officials 415 Second Street, NW, Suite 200 Washington, DC 20002 (202) 546-5400 California Department of Health Services California Indoor Air Quality Program Dr. Janet Macher Dr. Kenneth W. Kizer, ME, MPH, Director of CA Dept Health Services 2151 Berkeley Way Berkeley, California (510) 540-2469 Centers for Disease Control and Prevention (CDC) Division of Tuberculosis Elimination and Control 1600 Clifton Road, NE, Mailstop E-10 Atlanta, Georgia 30333 (404) 639-8120; (404) 639-1819 (voice activated, for ordering specific materials) FAX (404) 639-8628 RN Consultant: Susan Dougharty Gibson: (404) 639-8135 Centers for Disease Control and Prevention (CDC) Information Services National Center for Prevention Services 1600 Clifton Road, NE, Mailstop E-06 Atlanta, Georgia 30333 (404) 639-1819 (voice activated, for ordering materials/publications) FAX (404) 639-8628 Centers for Disease Control and Prevention (CDC) National AIDS Clearinghouse P.O. Box 6003 Rockville, Maryland 20849-6003 (800) 458-5231 - (301) 217-5343 - FAX - (301) 251-5343 Centers for Disease Control and Prevention (CDC) Office of Safety & Health 1600 Clifton Road Atlanta, Georgia 30333 (404) 639-3235 (copy of Biosafety in Microbiological & Biomedical Laboratories, 3rd Ed.) College of American Pathologists 325 Waukegan Road Northfield, Illinois 50093-2750 (708) 446-8800 Congress of National Black Churches 1225 I Street, NW, Suite 750 Washington, DC 20005 (202) 371-1091 - FAX (202) 371-0908 Department of Defense Office of the Assistant Secretary of Defense (Clinical Services) 1200 Defense Pentagon - Health Affairs Washington, DC 20301-1200 (703) 695-7116 Department of Veterans Affairs Office of Geriatrics and Extended Care (114) 810 Vermont Avenue, NW Washington, DC 20420 (202) 535-7165 - FAX (202) 535-7006 Drug Strategies 2445 M Street, NW, Suite 480 Washington, DC 20037 (202) 663-6090 - FAX (202) 663-6110 1199 National Health and Human Service Employee Union 330 West 42nd Street, 15th Floor New York, New York 10036 (212) 631-4580 - FAX (212) 695-0538 Food and Drug Administration 5600 Fishers Lane HFD (NLRC) Rockville, Maryland 20857 (301) 443-2410 - FAX (301) 443-9292 Hawaii (State of), Department of Health AIDS/STD Project 1250 Punchbowl Street Honolulu, Hawaii 96813 Health Care Finance Administration Hubert Humphrey Building, Room 314G 200 Independence Avenue, SW Washington, DC 20201 (202) 690-5727 - FAX (202) 690-6262 Health Care for the Homeless Information Resource Center John Snow, Inc. 210 Lincoln Street Boston, Massachusetts 02111 (617) 482-9485 - FAX (617) 482-0617 Health Resources & Services Administration 5600 Fishers Lane, Rm 7-05 Rockville, Maryland 20857 (301) 443-1993 - FAX (301) 443-9645 Home Health Services and Staffing Association (HHSSA) 115 D South Saint Asaph Street Alexandria, Virginia 23314 Mark Ranslem (703) 836-9863 Hunter College School of Health Sciences The Center for Occupational & Environmental Health 425 East 25th Street New York, New York 10010 (212) 481-8790 - FAX (212) 481-8795 Director: Daniel Kass (212) 481-4361 Indian Health Service 5600 Fishers Lane, Room 6-05 Rockville, Maryland 20857 (301) 443-1083 Infectious Diseases Society of America Yale University School of Medicine 333 Cedar Street, 201 LCI New Haven, Connecticut 06510-8056 (203) 785-4141 - FAX (203) 785-6179 Joint Commission on Accreditation of Healthcare Organizations (JCAHO) One Renaissance Boulevard Oakbrook Terrace, Illinois 60181 (708) 916-5600 Labor Institute, The 853 Broadway, Room 2014 New York, New York 10003 (212) 674-3322 - FAX (212) 353-1203 Lincoln Medical Education Foundation Attn: Tuberculosis Video 4600 Valley Road Lincoln, Nebraska 68510 (402) 483-4581 - FAX (402) 483-4184 Madigan Army Health Social Service Department Medical Center Tacoma, Washington 98431 (206) 968-2302 Massachusetts Refugee Health Program 305 South Street Jamaica Plains, Massachusetts 02130 (617) 522-3700 Migrant Clinicians Network 5524 Bee Caves Road, Building I, Suite 1 Austin, Texas 78746 (512) 327-2017 - (512) 327-0719 National Association of Community Health Centers, Inc. 1330 New Hampshire Avenue, Suite 122 Washington, DC 20036 (202) 659-8008 - FAX (202) 659-8519 National Association of County Health Officials 440 First Street, NW, Suite 500 Washington, DC 20001 (202) 783-5550 National Black Nurses Association 1511 K Street, NW, Suite 415 Washington, DC 20006 (202) 393-6870 - FAX (202) 347-3808 National Coalition for the Homeless 1612 K Street, NW, Suite 1004 Washington, DC 20006 (202) 775-1322 - FAX (202) 775-1316 National Commission for Clinical Laboratory Standards (NCCLS) 771 East Lancaster Avenue Villanova, Pennsylvania 19085 (215) 525-2435 National Commission on Correctional Health Care 2105 North Southport, Suite 200 Chicago, Illinois 60614-4017 (312) 528-0818 National Council of La Raza 810 First Street, NE, Suite 300 Washington, DC 20002 (202) 289-1380 - FAX (202) 289-8173 National Foundation for Infectious Diseases 4733 Bethesda Avenue, Suite 750 Bethesda, Maryland 20814-5228 (301) 656-0003 - FAX (301) 907-0878 National Health Care for the Homeless Council P.O. Box 68019 Nashville, Tennessee 37206-8019 (615) 226-2292 - FAX (615) 226-1656 National Heart, Lung and Blood Institute National Institutes of Health 9000 Rockville Pike Building 31, Room 5A52 Bethesda, Maryland 20892 (301) 496-5166 - FAX (301) 496-7408 National Institute of Allergy and Infectious Diseases (NIAID) National Institutes of Health 9000 Rockville Pike Building 31, Room 7A03 Bethesda, Maryland 20892 (301) 496-2263 - FAX (301) 496-4409 National Institute of Nursing Research National Institutes of Health Building 45, Room 3AN-12 MSC 6300 Bethesda, Maryland 20892-6300 (301) 594-6908 - FAX (301) 480-8260 National Jewish Center for Immunology and Respiratory Medicare TB Office K624 1400 Jackson Street Denver, Colorado 80206 (303) 398-1700 - (800) 423-8891, extension: 1700 National Leadership Coalition on AIDS 1730 M Street, NW, Suite 905 Washington, DC 20036 (202) 429-0930 - FAX (202) 872-1977 National Minority AIDS Council 300 I Street, NW, Suite 400 Washington, DC 20002 (202) 544-1076 - FAX (202) 544-0378 National Public Health Information Coalition P.O. Box 941804 Atlanta, Georgia 30341-0804 National Rural Health Association 1 West Armour, Suite 301 Kansas City, Missouri 64111 (816) 756-3140 - FAX (816) 756-3144 National Technical Information Service U.S. Department of Commerce 5285 Port Royal Road Springfield, Virginia 22161 (800) 553-6847 National Tuberculosis Model Centers Francis J. Curry, National Tuberculosis Center 3180 18th Street, Suite 101 San Francisco, California 94110 (415) 502-4600 - FAX (415) 502-4620 Director: Gisela Schecter, MD, MPH Education Director: Wesley S. Wong National Tuberculosis Model Centers (continued) National Tuberculosis Center, UMDNJ University of Medicine and Dentistry of New Jersey 65 Bergen Street, Suite GB-1 Newark, New Jersey 07107-3001 (201) 982-3270 - FAX (201) 982-3268 Education Director: Debra Bottinick New Hampshire Division of Public Health Services 6 Hazen Drive Concord, New Hampshire 03301 (603) 271-4661 New York Academy of Medicine 1216 Fifth Avenue New York, New York 10029 New York City Department of Health Bureau of Tuberculosis Control 125 Worth Street, Box 74 New York, New York 10013 (212) 788-4153 - FAX (212) 788-4179 Nursing Organization Liaison Forum American Nurses Association 600 Maryland Avenue, SW Washington, DC 20024 (202) 651-7120 Office of Minority Health 5515 Security Lane, Suite 1000 Rockville, Maryland 20852 (301) 443-5084 - FAX (301) 594-0767 Office of Minority Health Resource Center (OMH-RC) PHS-DHHS PO Box 37337 Washington, DC 20013-7337 (800) 444-MHRC [(800) 444-6472] TDD: (301) 589-0951 FAX: (301) 589-0884 Pharmaceutical Manufacturers Association 1100 15th Street, NW, Suite 900 Washington, DC 20005 (202) 835-3550 - FAX (202) 835-3597 Services Employees International Union, AFL-CIO 1313 L Street, NW Washington, DC 20005 (202) 898-3434 - FAX (202) 898-3491 Society for Hospital Epidemiology of America 875 Kings Highway, Suite 200 Woodbury, New Jersey 08096 (609) 845-1636 - FAX (609) 853-0411 Substance Abuse and Mental Health Services Administration 5515 Security Lane Rockwall II Building, Room 880 Rockville, Maryland 20852 (301) 443-8391 - FAX (301) 443-8345 UMDNJ New Jersey Medical School National Tuberculosis Center 65 Bergen Street, Suite GB1 Newark, New Jersey 07107-3001 (201) 982-3270 - FAX (201) 982-3268 United States - Mexico Border Health Association JUNTOS Program 6006 North Mesa, Suite 600 El Paso, Texas 79912 (915) 581-6645 - FAX (915) 833-4768 Fernando J. Gonzalez, MD, MPH Bi-National TB Control Project Coordinator University of California, San Diego Medical Center Preventive Pulmonary Medicine 225 Dickinson Street San Diego, California 92103-8377 Attn: Andrew Ries, MD University Hospital & Clinics Infection Control Department DC092.00 212 Dockery Hall One Hospital Drive Columbia, Missouri 65212 U.S. Department of Health and Human Services Division of Federal Occupational Health (301) 594-0260 U.S. Department of Labor - OSHA Office of Training and Education 1555 Times Drive Des Plaines, Illinois 60018 (708) 297-4810 U.S. Government Printing Office Superintendent of Documents Washington, D.C. 20402 (202) 512-2356 Utah (State of) Industrial Commission of Utah Utah Job Safety and Health Consultation Services 160 East 300 South, 3rd Floor PO Box 146650 Salt Lake City, Utah 84114-6650 (801) 530-6855 / (800) 222-1238 - FAX (801) 530-6992 Consultant: Eldon Tryon, PhD Wasatch Homeless Health Care Program 404 South 400 West Salt Lake City, Utah 84101 (801) 364-0058 - FAX (801) 364-0161 APPENDIX B Centers for Disease Control and Prevention, Education and Training Materials Order Form. Division of Tuberculosis Elimination Educational and Training Materials Please indicate desired quantity in the blank provided. All materials are free of charge. For Health Care Providers Multidrug Resistant Tuberculosis - 1994 ___ (00-6529) 8-page article on the causes, treatment, and control of drug-resistant tuberculosis Core Curriculum on Tuberculosis, 3rd Edition - 1994 ___ (00-5763) 95-page training guide on important clinical and public health aspects of TB control ___ (00-6077) Set of 82 slides that accompany this training guide (Slides limited to one set per order) TB Care Guide - 1994 ___ (00-6470) 57-page booklet for clinicians on care of TB patients, with a tear-off card for dosage calculation and reference TB Treatment: A Clinical Guide - 1994 ___ (00-6471) Fold-out chart with 8 panels with tables on TB treatment and medications for clinicians' reference TB Facts for Health Care Workers - 1993 ___ (00-5655) 7-page booklet on TB transmission, diagnosis, prevention, and treatment Think TB! - Poster listing the symptoms of tuberculosis ___ (00-6186) English language - 1992 ___ (00-6406) Spanish language - 1993 Improving Patient Adherence to Tuberculosis Treatment - 1994 ___ (00-5988) 55-page booklet on measuring, predicting, and improving compliance Mantoux Tuberculosis Skin Testing - Visual aids for training to administer and interpret the Mantoux test ___ (00-5564) Wall chart - 1990 ___ (00-5457) Videotape - 1991 TB/HIV - The Connection: What Health Care Workers Should Know - 1993 ___ (00-5316) 16-page booklet on diagnosis, prevention, and treatment of TB in persons with HIV infection Reported TB in the United States - 1993 ___ (00-6481) Statistics on tuberculosis cases and case rates reported for 1993 For Drug Treatment Center Staff What Drug Treatment Centers Can Do To Prevent Tuberculosis - 1991 3-page pamphlet on TB infection, disease, screening, and prevention for drug treatment centers ___ (00-5748) English Language ___ (00-6038) Spanish language For Correctional Facility Inmates Tuberculosis Facts - 1991 - Pad of 40 tear-off sheets providing basic information on the subject specified: English language ___ (00-5983) Exposure to TB ___ (00-5984) The TB Skin Test ___ (00-5981) You Can Prevent TB ___ (00-5985) TB Can Be Cured ___ (00-5982) TB and HIV (The AIDS Virus) Spanish language ___ (00-6200) Exposure to TB ___ (00-6201) The TB Skin Test ___ (00-6198) You Can Prevent TB ___ (00-6202) TB Can Be Cured ___ (00-6199) TB and HIV (The AIDS Virus) GUIDELINES TB PREVENTION AND CONTROL ___ (00-5856) Guidelines for preventing the Transmission of Mycobacterium tuberculosis in Health Care Facilities. MMWR, 1994. ___ (00-6410) Tuberculosis Control Laws - United States 1993. MMWR, November 12, 1993. ___ (00-6330) Control of Tuberculosis in the United States. Reprint from the American Review of Respiratory Disease, December 1992. ___ (00-6224) National Action Plan to Combat Multidrug- Resistant Tuberculosis. MMWR, June 19, 1992. ___ (00-6223) Prevention and Control of Tuberculosis in Migrant Farm Workers. MMWR, June 5, 1992. ___ (00-6148) Prevention and Control of Tuberculosis Among Homeless Persons and Prevention and Control of Tuberculosis in U.S. Communities with At-Risk Minority Populations. MMWR. April 17, 1992 ___ (00-5897) Prevention and Control of Tuberculosis Among Foreign-Born Persons Entering the United States. MMWR, July 13, 1990. TB SCREENING AND TREATMENT ___ (00-6453) Treatment of Tuberculosis and Tuberculosis Infection in Adults and Children. Reprint from the American Journal of Respiratory and Critical Care Medicine, May 1994. ___ (99-3307) Screening for Tuberculosis and Tuberculosis Infection in High-Risk Populations and Use of Preventive Therapy for Tuberculosis Infection in the U.S. MMWR, March 18, 1990. ___ (00-6225) Management of Persons Exposed to Mulitdrug- Resistant Tuberculosis. MMWR, June 19, 1992. For Patients and the General Public Questions and Answers about TB - 1994 ___ (00-6469) 16-page booklet about TB transmission, skin test, and treatment, including DOT and side effects of medications Stop TB! - 1994 ___ (00-6474) Poster describing the transmission and pathogenesis of TB ___ (00-6475) Pad of 50 tear-off sheets duplicating the Stop TB! poster Tuberculosis - Get the Facts! - 1990 One-page pamphlet on basic facts about TB transmission, infection, and the tuberculin test ___ (00-5743) English language ___ (00-5772) Spanish language Tuberculosis - The Connection Between TB and HIV (the AIDS Virus) - 1990 One-page pamphlet on the risk of HIV-related TB, tuberculin testing, and preventive therapy ___ (00-5738) English language ___ (00-5745) Spanish language TB/HIV Double Trouble - 1992 ___ (00-6154) Poster stressing the importance of tuberculin testing for persons with HIV infection To order tuberculosis educational and training materials or guidelines, you may (1) call the National Center for Preventive Services Voice Information System (recording) at (404) 639-1819; (2) FAX this form to Information Services at (404) 639-8628; OR (3) mail this form to: Information Services, NCPS, CDC, 1600 Clifton Road NE. Mailstop E-06, Atlanta, Georgia 30333. Please provide the following information: Name: _______________________________________________________ Address: _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ Phone: ( ) _______________________________________________ |
