Texas Administrative Code
Title 25 - HEALTH SERVICES
Part 1 - DEPARTMENT OF STATE HEALTH SERVICES
Chapter 97 - COMMUNICABLE DISEASES
Subchapter H - TUBERCULOSIS SCREENING FOR JAILS AND OTHER CORRECTIONAL FACILITIES
Section 97.177 - Prevention of Disease

(1) To prevent the spread of Mycobacterium tuberculosis in the facility, it is important to recognize and isolate inmates (in appropriate TB respiratory isolation facilities) who have symptoms suggestive of TB disease. Officers and health care staff shall suspect TB in inmates with a persistent cough (more than two weeks duration), especially in the presence of other symptoms or signs compatible with TB, such as weight loss, night sweats, bloody sputum, anorexia or fever. These inmates shall be evaluated for TB no later than 72 hours after observation or report of symptoms. The inmate shall not leave appropriate TB respiratory isolation until TB is excluded or the inmate is on therapy and documented to be noninfectious.

(2) Inmates suspected of having TB shall be placed in respiratory isolation until they are no longer infectious. Inmates who are cases or suspects shall be released from isolation only after infectiousness has been ruled out. Three consecutive negative sputum smears must be obtained before an inmate who has had a positive smear can be considered noninfectious. At least two of the sputum specimens shall be collected early in the morning of consecutive days.

(3) Cough-inducing procedures can place health staff and nearby inmates at special risk of acquiring TB infection. These procedures include sputum collection, bronchoscopy, and the administration of aerosolized pentamidine. It is very important to carry out such procedures in an individual room or booth with negative pressure relative to adjacent rooms and hallways, ideally with room or booth air exhausted directly to the outside and away from all windows and air intake ducts. Inmates should remain in the booth or treatment room and not return to common areas until coughing has subsided.

(4) The installation of ultraviolet (UV) lights may be considered in some facilities, especially in high volume, high turnover holding facilities. However, UV lights shall be used only to supplement other control measures (such as good ventilation). Proper precautions and scheduled maintenance of the lights are essential.

(1) Jail facility employees and volunteers with current pulmonary or laryngeal TB pose a risk to inmates and others while they are infectious; therefore, stringent work restrictions for these persons are necessary. They shall be excluded from work until adequate treatment is instituted, cough is resolved, sputum is free of bacilli on three consecutive smears (at least two of the sputum specimens shall be collected early in the morning of consecutive days), and they have received a release for work signed by their physician or the local health authority. Employees and volunteers with current TB at sites other than the lung or larynx usually do not need to be excluded from work if concurrent pulmonary TB has been ruled out. Employees and volunteers who discontinue treatment before the recommended course of therapy has been completed shall not be allowed to work until treatment is resumed, an adequate response to therapy is documented, they have three consecutive negative sputum smears (at least two of the sputum specimens shall be collected early in the morning of consecutive days), and they have received a release for work signed by their physician or the local health authority.

(2) Employees and volunteers who are otherwise healthy and receiving treatment for latent TB infection shall be allowed to continue usual work activities.

(3) Employees and volunteers who cannot take or do not accept or complete a full course of treatment for latent TB infection shall have their work situations evaluated to determine whether reassignment is indicated. Work restrictions may not be necessary for otherwise healthy persons who do not accept or complete treatment for latent TB infection. These persons shall be counseled about the risk of developing disease and shall be instructed to seek evaluation promptly if symptoms develop that may be due to TB, especially if they have contact with high-risk inmates (i.e., inmates at high risk for severe consequences if they become infected.)