By Mueller, Julie
Corrections Today , Vol. 58, No. 6
When Tammy Nelson began her nursing career at a correctional facility, she knew she would face situations she had not dealt with before. However, she did not realize that she would spend much of her medical career trying to prevent a disease the world had nearly conquered - tuberculosis (TB). Even though TB had once been the scourge of the civilized world, Nelson says TB seemed to be a thing of the past when she got out of nursing school.
"When I started working in correctional facilities, most nurses would give a coughing inmate an over-the-counter cough suppressant. Now, everyone realizes that a cough may be a sign of TB," explains Nelson.
Stopping the spread of TB has become a top priority because there are more than 24,000 new cases of TB every year in the United States, and TB rates in prisons and jails typically are five times higher than in the general population. Contributing to the TB challenge are the jails and prisons themselves. Most were not designed to have ventilation systems that meet standards for preventing the spread of TB.
Inmates and even correctional health care workers are more likely to get TB than people in the general population because correctional facilities house a higher percentage of former substance abusers. HIV infections also occur in greater percentages in prisons and can hasten the spread of TB.
Furthermore, Nelson believes that many inmates have not taken care of themselves prior to incarceration, and this-makes them more susceptible. She says, "For many of these people it's the first time they are being examined and treated regularly for any health problems."
Treating the Disease
Nelson works for Correctional Medical Services Inc. (CMS) which provides health care to more than 150,000 inmates in 27 states. Her first days as a correctional nurse were in Illinois, when the company began providing health care to inmates there.
Medical experts say swift and accurate diagnoses literally can mean the difference between life and death. Clearly, the work that health care professionals such as Nelson do is the first line of defense in correctional facilities.
When CMS began providing health care to inmates in the state of Missouri, the first order of business was to provide extensive training for nurses. The goal was to improve the nurses' ability to spot symptoms and identify positive TB test results more quickly and efficiently. Nelson says, "The more often nurses perform TB screening, the easier it becomes to spot certain signs of the disease."
According to Nelson, they also began extensive follow-up programs with inmates who had the disease, and began tracking their health closely. Patients are required to come in for medicine about twice a week and take it in the presence of a health care staff member. "This is the only way that we can be sure they are getting the full treatment, and be sure the disease is being properly fought inside the institution," she says.
Medical experts say when patients stop taking the medication at some point during the year, it can keep the patient from getting well and lead to a strain of TB which is partially resistant to such treatment. This is why health care staff members emphasize direct observation of patients taking their medication.
In 1994, eight tuberculosis cases were identified in five Missouri correctional institutions. Nearly all of the TB patients had the disease when they entered the facilities. Two of these patients had TB strains that were resistant to multiple-drug treatments. This type of resistance often develops among TB patients who start, but do not complete, drug treatments to fight the disease.
However, through the proper use of isolation, ventilation and aggressive treatment, the disease did not spread into the rest of the Missouri inmate population. Nelson credits the screening and follow-up treatment medical staff conducted for keeping these eight cases from creating a more serious TB problem. …