Tuberculosis surveillance practices in long-term care institutions

Area of Science:

• Public Health
• Infectious Disease Control
• Geriatric Care

Background:

• Tuberculosis (TB) remains a significant public health concern, particularly in vulnerable populations such as the elderly residing in long-term care facilities.
• Effective TB surveillance is crucial to prevent outbreaks and protect residents and staff within these settings.
• Current TB skin-testing practices in long-term care facilities require thorough evaluation to ensure adequacy and compliance with recommended guidelines.

Purpose of the Study:

• To assess the current tuberculosis (TB) skin-testing practices in long-term care facilities for the elderly in Toronto, Ontario.
• To identify variations in TB skin-testing protocols between different types of facilities, specifically nursing homes (NHs) and Homes for the Aged (HFAs).
• To determine the extent of formal TB skin-testing programs and adherence to best practices in these institutions.

Main Methods:

• A telephone survey was conducted using a standardized 25-item questionnaire.
• The survey targeted 29 nursing homes (NHs) and 26 Homes for the Aged (HFAs) in metropolitan Toronto.
• Data collected included information on formal TB skin-testing programs, preadmission testing, annual testing, and interpretation of test results.

Main Results:

• Thirty-one percent of surveyed facilities lacked a formal tuberculin skin-testing program.
• Nursing homes (NHs) demonstrated significantly poorer TB skin-testing practices compared to Homes for the Aged (HFAs).
• HFAs showed higher rates of preadmission testing, measurement of induration, and correct definition of a positive test compared to NHs.

Conclusions:

• Tuberculosis surveillance practices in Toronto's long-term care institutions are inadequate, potentially hindering effective outbreak investigation.
• Homes for the Aged (HFAs) exhibited superior TB skin-testing practices, likely due to provincial legislative requirements for TB surveillance.
• There is a clear need for enhanced education and standardized implementation of tuberculin skin-testing policies and procedures for staff in both NHs and HFAs.