Responding to a community tuberculosis outbreak: Public health nursing interventions

The role of the public health nurse in responding to a TB outbreak is instrumental in controlling the disease and preventing further spread in a community. This presentation focuses on the interventions carried out by public health nurses in Grand Forks, ND where a TB outbreak occurred in late 2012 and early 2013. The population affected had unstable housing, low socioeconomic status and other risk factors for tuberculosis. There were a total of 20 adult and pediatric cases of TB identified among a closely connected social network with multiple and prolonged exposures to other residents of the community. Public health nurses were responsible for an array of activities from the Public Health Wheel of Intervention including: surveillance, health event investigation, outreach, screening, referral and follow up, case management, and delegated functions such as directly observed therapy for medication compliance. The public health nurses collaborated with health care providers and area schools to establish a TB task force. The task force served as a conduit of information to the public through the media. TB skin testing and health teaching were provided at three schools, multiple worksites, and at the local health department. As a result, 40 individuals were placed on preventive therapy for latent TB infection. Social determinants of health such as poverty, lack of housing, unemployment and incarceration were impediments to successful treatment; however, the public health nurses remained committed to the goal of 100% completion of treatment for all TB patients.