Department of Veterans Affairs
Veterans Health Administration
Program and Facility Planning Guidance
for Tuberculosis Programs
August 18, 1995
OVERVIEW
Over the last several years, the issue of tuberculosis (TB) has been prominent in both the medical
literature and the national press. This has been emphasized in the last year coincident with an increased
pubic awareness of emerging and re-emerging pathogens on the national and global level. Finally, and
after much work, the actual number of new cases of active tuberculosis disease is decreasing nationally
with the most notable decrease in the New York area. However, the TB epidemic continues particularly
along the coast of the United States. No section of the country has been completely spared, however, as
cases of tuberculosis have been identified in all VHA Regions.
To effectively plan and implement a tuberculosis program facilities must obtain information on current
and projected TB workload, evaluate and define missions related to TE, and develop integrated plans for
patient care, employee healtf4.and enhance facility controls. This TB program guidance will provide a
consistent framework for such VA TB program planning,
This planning document is organized in a format that prioritizes overall guidance for TB control based on
clinical and epidemiologic priorities. It specifies infection control practices and regulatory requirements,
while incorporating work practice controls, engineering, controls, and personal protective equipment into
the overall guidance. This is not designed to be a regulatory compliance document, but rather to
integrate the various components of tuberculosis control strategies into the medical facility culture.
CHARACTERISTICS OF A TB PROGRAM
I. Assign Responsibility
While all programs within VA Medical Centers are the ultimate responsibility of the Medical Center
Director, it is appropriate to assign the responsibility for the tuberculosis program to a specific qualified
person or group of people within the facility. Each facility is to have a coherent, practical and
implementable program. Then the program must be implemented, monitored, and evaluated. The
program will also ensure that a mechanism will be established to identify responsible parties. for
components of the program, establish the program structure, and define the hierarchy of responsibility
from TB program officials to the facility Director. Included in this group should be representation from
Infection Control, Medical Staff (Infectious Diseases and Pulmonary Medicine if available), Nursing,
Occupational Health, Safety/Industrial Hygiene, and Engineering, thus assuring the availability of
expertise in all areas of TB control as well as ownership of the program through a multidisciplinary input
process.
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