BUMEDINST 6224.8B - Tuberculosis Control Program Flashcards
Which instruction provides policy and guidance for controlling tuberculosis (TB) among Department of the Navy (DON) military personnel and Military Sealift Command (MSC) civilian mariners (CIVMAR)?
BUMEDINST 6224.8B, Tuberculosis Control Program
What form is the Initial Tuberculosis Exposure Risk Assessment?
NAVMED 6224/7
What form is the Interim Tuberculosis Exposure Risk Assessment?
NAVMED 6224/8
What form is the Monthly Evaluation for Patients receiving Treatment for Latent Tuberculosis Infection?
NAVMED 6224/9
What form is the Adult Immunizations Record?
NAVMED 6230/4
What form is the Child Immunizations Record?
NAVMED 6230/5
Records created as a result of BUMEDINST 6224.8B, Tuberculosis Control Program, regardless of media and format shall be managed per what instruction?
SEVNAV-M 5210.1
What needs to occur to significantly reduce the spread of Tuberculosis (TB)?
Early detection and respiratory isolation of persons infected with TB
What is the strategy to control tuberculosis?
a. To promptly detect, treat and report persons who have contracted clinically active TB
b. To protect persons in close contact with patients with active TB
c. To prevent TB in DON MSC and CIVMAR through early detection and treatment of latent TB
d. Assessment of DON contract workers and contract healthcare workers
Pertaining to TB the navy is only required to adhere to federal regulations , but not state and local law if they conflict with federal law. T or F?
True
The skin and blood test required for entry into Naval service, identifies individuals asymptomatically infected whith what complex bacteria known to cause Tuberculosis (TB)?
Mycobacterium Tuberculosis
Appropriate TB testing, identifies Individuals that are at increased risk for developing active TB, but are not infectious. What are they diagnoised with?
Latent Tuberculosis Infection (LTBI)
All Navy and Marine Corps accessions, and all individuals beginning employment as Civilian Mariners (CIVMARs) for the Military Sealift Command (MSC) must be screened for what?
Latent Tuberculosis Infection (LTBI) unless previously documented of TB Infection
What must all personnel be screened for during their operational suitability screening?
Latent Tuberculosis Infection (LTBI)
Documented screening or testing for LTBI within what time frame of reporting aboard a commissioned vessel is acceptable?
6 months
Which form should be used to screen all Active duty and Reserve personnel during the PHA to determine their TB exposure history and risk of acquiring TB?
NAVMED 6224/8, Interim Tuberculosis Exposure Risk Assessment
CIVMARs will be screened or tested _______ or during their periodic physical examination at the direction of MSC Fleet Surgeon based on their different risk profile in comparison to uniformed service members
Annually
TB screening must be performed on all personnel prior to or within how many months of arrival on a commissioned vessel?
6 months
It is no longer required that all personnel must have Latent Tuberculosis Infection (LTBI) test results documented within the 6 months prior to separation or retirement. T or F?
True
What is the approved tuberculin routine skin test?
Mantoux test
Tuberculosis Skin Test (TST) test results can be entered into AHLTA, MRRS, or which other authorized electronic medical information system?
Shipboard Non-Tactical ADP Program (SNAP) Automated Medical System (SAMS)
What information is included when documenting a Tuberculosis Skin Test (TST)?
- date
- type
- strength of tuberculin
- manufacturer
- lot number
- route
Within how many hours after Purified Protein Derivative (PPD) administration must the TST reaction be read?
48-72 hours
If person, returns more than 72 hours after the Tuberculosis Skin Test (TST) placement, what is the next process?
Record results as “Not Read” and thenapply a TST on the opposite forearm
Measurement of the TST reaction is to the nearest whole millimeter (mm). How would a no induration be documented?
“0 mm” or “zero mm”
When should additional LTBI screening and subsequent testing be done?
- As directed by combatant commanders
- As part of a contact or outbreak investigation
- If clinically indicated by an individual practicionar based on history, physical, PHA or PDHA
- And as recommended by Navy Environmental Preventative Medicine Unit (NAVENPVNTMEDU)
What is the normal rate of newly-identified LTBI converters to personnel tested per year in most Navy and Marine Corps settings based on historical TST results associated with routine (non-targeted) screening?
1-2 percent
If the rate of newly identified converters is two times greater than the expected baseline conversion rate of the command among any group tested, who needs to be contacted for specific guidance?
the cognizant Navy Environmental Preventative Medicine Unit (NAVENPVNTMEDU)
A TST may be placed on the same day parenteral live-attenuated virus vaccines are given or at least how many weeks later?
4 weeks
Are TST considered safe for pregnant women?
They are both safe and reliable and should be performed if needed
If they are undergoing further evaluation, what should the service members with positive TST do?
They should not deploy until the evaluations are complete. (i.e. Chest X-rays & mycobacterium cultures)
All individuals with a TST induration that is greater than or equal to how many mm must be evaluated to determine if their test is positive base on risk factors?
5 mm
An increase in reaction size of how many mm or more, within a three-year period is also considered a skin test conversion or positive test indicative of a recent infection with TB?
10 mm
Service members and individuals assigned to operational military forces, including shipboard personnel, without risk factors for acquiring TB are in what risk group? What is their TST induration?
Low Risk
Greater than or equal to 15 mm
Recent immigrants (within the last 5 years) from high TB prevalence countries, Myobacteriology laboratory personnel, and persons with clinical conditions that place them at increased risk are designated what risk group?
Medium Risk
Greater than or equal to 10 mm
Recent close contacts of active TB disease patients, persons with fibrotic or other changed on chest radiograph consistent with prior TB, and patients suspected of having active TB diseas are designated as what risk group?
High Risk
Greater than or equal to 5 mm
To determine if all persons have active TB disease, ensure all persons newly identified as having a positive TST are evaluated by who?
MO, Nurse Practitioner, PA, or IDC
Chest x-rays should be examined for _______ changes consistent with old TB infectionand for any signs of active TB.
Fibrotic
_______ women also should have active TB ruled out with chest x-ray using appropriate shielding.
Pregnant
A person with suspected active TB disease should immediately be what?
Masked, Isolated, and reffered to an appropriate MTF provider
What is the preferred isoniazed (INH) treatment regimen?
INH 5 mg/kg (300 mg max) daily for 9 months
What is the alternate isoniazed (INH) treatment regimen?
INH 15mg/kg (900 mg max) bi-weekly for 9 months with directly observed theraphy (DOT)
How often must follow ups be conducted for individuals receiving therapy for LTBI until treatment is completed?
Monthly
What is the recommended mechanism to assure LTBI treatment compliance whenever feasible?
directly observed theraphy (DOT)
Which form should be used to document patient education and counseling?
SF 600, Medical Record Chronological Record of Medical Treatment
Persons on treatment for LTBI often miss doses. The 9-month daily Isoniazid (INH) regimen should not be restarted if at least how many doses of INH can be administered within a 12-month period?
270 doses
Patients must be examined to exclude active TB disease, if the treatment has been interrupted for more than how many months ?
2 months
What is the ICD 9 code that you should use when evaluating a patient in AHLTA for TB?
ICD9M code v74.1
“Screening exam for pulmonary TB”
What should you do if you suspect a patient has a strain of Tb that is resistant to INH?
Consult Navy Environmental Preventive Medicine Unit (NAVENPVNTMEDU) for treatment plan
Do you need to do baseline lab testing for someone starting INH therapy?
No you do not need to routinely do base line labs prior to treatment
Only do a LFT for those at risk of liver disease
Which form must be used to document the need for continued LTBI treatment for all naval service beneficiaries who transfer from the treating health care facility or leave the military service before completing a course of treatment for LTBI?
NAVMED 6224/9, Monthly Evaluation of Patients Receiving Theraphy for Latent Tuberculosis Infection (LTBI)
Where can members members leaving active service eligible for continued TB treatment and follow up care?
Veteran’s Administration (VA)
Upon discoveray of suspected or confirmed case of active tuberculosis (TB) in a service member assigned to Navy or Marine Corps operating forces, the CO ir OIC must notify who?
Cognizant Navy Enviromental Preventative Medicine Unit (NAVENPVTMEDU) and local health department
Upon completion of the cognizant NAVENPVTMEDU TB contact investigation, assited by command medical personnel, the NAVENPVTMEDU will provide an investigation report to the Command, cognizant Fleet.Type Commander Surgeon, and who?
Navy and Marine Corps Public Health Center (NMCPHC)
Who will conduct the TB contact investigation on persons not assigned to naval operational forces?
The MTF will notify the cognizant NAVENPVTMEDU upon initiating a contact investigation and will submit the completed investigation report to who?
Servicing MTF
Navy Medicine Region and Navy and Marine Corps Public Health Center (NMCPHC)
Which reference contains the guidance that should be employed when conducting TB contact investigations with suspected transmission within aircraft cabins?
WHO/HTM/TB/2008.399
Within what time frame must a Medical Event Report be submitted for all new cases of active TB or suspected new cases of active TB by the ship or station?
24 hours
What is the minimum particulate respirator size that medical department personnel must wear when working in rooms or spaces containing a person with known or suspected active TB?
N95 mask
