TB in the workplace

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Ever since the HIV epidemic in the 1980’s the incidence of Tuberculosis has been increasing steadily the past 2 decades. It was almost considered to be eradicated in the united states, and I don’t think I have to explain why working in a correctional setting as a nurse makes me feel a little uncomfortable with this disease becoming more prevalent. Poor hygiene and the crowded conditions of course contribute to the growing numbers of active cases. But I don’t think I can blame the governments or jail administrators for this risk factor. The system is just overwhelmed. There is less money in the budget, more people getting arrested than ever before, and an increasing strain on the healthcare system. What does make me mad is that there are risk factors that can be managed much better and officials continue to ignore them.
There is a jail standard that inmates MUST be screened with a history and physical with a PPD test, and assessment of TB risk factors. That’s all good, except that the standard says that it does not have to be done until the inmate has been incarcerated for 14 days! 2 weeks is plenty long enough for an individual with an active case to be sitting in an open housing, general population cell to cause a small epidemic. As a nurse manager I try to use professional relations with the correction officials to understand that even though it looks like it costs more to staff a few more nurses to get this type of screening done sooner, in the long run their potential costs for medical expenses, and possible law suits could be far outweigh the initial costs. Their side of the story is based on the statistic that most inmates that are arrested have an average stay of 10 days. This is true for many smaller facilities. But there is another statistic that says if you are arrested once you are usually arrested many times in your whole lifetime. I try to relate that to them, the possibility of an infected person spreading TB around for a few days, then leaving and coming back a few months later and doing the same thing. If we can document his infection one time and start treatment, then the next time he comes in at least there will be a record (hopefully computerized) that alarms medical staff for the need to isolate, continue treatment, or whatever is necessary before the patient has a chance to keep spreading TB around in a setting that is basically one big Petri-dish.

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