Care prevention and management of tuberculosis

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Starting treatment > Contact tracing and investigation
  • Standard statement
  • Rationale
  • Resources
  • Professional practice
  • Outcome
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Contact tracing and investigation is carried out according to locally agreed protocols

 

a group of people

Identification of vulnerable contacts (click to view)
Contact investigation is recommended for those closest to the patient, as they are at the highest risk of being infected with TB. The process varies according to available resources, but as a minimum anyone in the same household as a patient with AFB smear-positive TB who has symptoms should themselves be investigated for TB. Children aged under 5 years and anyone with HIV infection are at the highest risk when exposed to sputum smear-positive TB and should therefore be prioritised for investigation. If the index case has drug-resistant TB then it should be assumed that any contacts may also be drug resistant if they are found to be infected or have symptoms of active disease.
learn more Learn more: Risk factors and insight of what is a skin test for TB
nurse and patient
Identification of active cases (click to view)

Contact investigation is the most effective means of active case detection due to the fact that the people closest to a recently diagnosed case of sputum smear-positive TB are the most likely to be infected or themselves have active disease. The investigation may identify the person from whom the disease was contracted who may be unaware of their condition and therefore remain untreated and infectious. Although always a possibility, sources of adult TB are not often detected as the patient could have been infected at any previous time in their lives.  If however the patient is a child it is likely that they have recently been infected by an adult with active disease, such as a member of their household, close relative or family friend.

It is important to ask every patient at the start of treatment whether or not they know anyone who is unwell or suffering from similar symptoms to their own.
mother, child and nurse
Education (click to view)

The investigation of at least the household contacts provides a valuable opportunity to educate people who have potentially been infected with TB so they can recognise signs and symptoms and seek the necessary help and treatment if they develop the disease in the future. This is also important where resources are not available to investigate any further than the patient’s household. Patients themselves need to be equipped and encouraged to discuss their condition with others who have been in contact with them and are showing signs and symptoms of disease.

 
Reflect on
• how you educate your new and existing TB patients and their contacts on how to prevent the spread of TB
and
• what symptoms to look for to encourage others to go for a TB test


 
education
Preventive therapy (click to view)

Treatment of latent TB infection to prevent the development of active disease is most effective for children and other vulnerable people who have been infected by the patient. Any possibility of active disease must be ruled out before preventive treatment is started in order to avoid the possibility of partial treatment, which could lead to the development of drug resistance.
Where available, tuberculin skin testing can identify latent TB and preventive treatment can be offered to those at highest risk of developing disease. Where tuberculin is not available, The Union recommends that in the absence of active disease, preventive therapy should be offered to all children aged under 5 living in the same household as a smear-positive case of TB.

For details of the treatment of infected children preventive see Chapter 8 of Management of the child with cough or difficult breathing

learn more Read more: TB medicines for children WHO 2008

For more information on Tuberculin test – see Identifying TB

child taking medication
Sensitivity and discretion (click to view)

Contact tracing can often be a traumatic experience for the patient, who may feel very exposed and vulnerable due to the stigmatising nature of TB, so it is vital that the whole process is handled with as much sensitivity and discretion as possible. Every effort must be made to maintain the patient’s confidentiality.

Consider the need to be sensitive when addressing a patient’s need for confidentiality with their family, while trying to encourage them to gain support from their family as well as to prepare them for potential investigation for TB

learn more Learn more: About stigma
learn more Reflect on your practice
family watching tb video
  • Time and space is required for a confidential discussion with the patient about the importance of identifying anyone else they are in close contact with who may be infected with TB, especially children under five and anyone they know to be infected with HIV.
  • Health-care workers involved in caring for TB patients need to understand the disease and how it is transmitted in order to assess levels of risk accurately and prioritize those who need investigation.
    learn more Tools for contact tracing
    learn more Contact tracing form
  • tb nurse

     

    learn more Audit your contact tracing

    Check Your Practice

    When is contact tracing initiated in your clinic?

    At initial assessment

    Yes

    No

    After a positive diagnosis for TB is made

    Yes

    No

    If you do not engage in contact investigation, who is responsible for this?

     

    Your Action Plan for Improvement

    Use the following box to develop an action plan on how you will improve
    your practice with regards to organisation of DOTS for your patients

    Things you will change in your practice to train DOTS workers

    Things you will change in your practice to support DOTS workers and communicate with them to ensure
    patients are receiving their treatment and all necessary documentation is completed

    Things you will change about how others in your team engage with and support DOTS workers

    List yours and others training needs and identify how you will address them to
    enable best practice to support the DOTS strategy

     

    Please print this form and begin developing your practice

     

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