Infectious and non-infectious housing programs

“Bissell House” - housing program for inadequately housed patients with infectious TB and who are capable of independent living.
“500 West” - housing program for homeless TB patients who are non-infectious and capable of independent living.

What is it: 
Short term housing, and supportive services, for inadequately housed patients with TB. 

Why this is a best practice:
The Bissell House program provides a cost effective, safe alternative to acute care hospitalization for inadequately housed patients with infectious TB.  The patient must be able to live independently.  Bissell cottages have kitchens and residents are provided food, laundry and other services.  Isolation is monitored through an electronic surveillance system using ankle bracelets.  Patients who need long periods of isolation find the Bissell House a more desirable option than prolonged hospitalization.  Cost analysis of acute care hospitalization compared to Bissell House demonstrates significant savings.    

The downtown hotel program “500 West” provides short term housing for homeless patients with non-infectious active TB.  Providing secure housing reduces the probability of a patient becoming lost to care and allows the TB Program to monitor treatment to ensure a successful outcome.  Gift cards are provided to purchase food and meals.  Hygiene items are provided and referrals are made to programs that assess the patient’s eligibility for services and income to promote independent living.   
 
Resources required (staff, time, tools):

Housing appropriate for infectious and/or non-infectious patients.  Agreements negotiated for stable living options (leases, MOUS, etc.) Staff Time: PHN Supervisor, PHN Case Manager, Housing Coordinator, Outreach Worker and Communicable Disease Investigator
Grocery store (develop payment agreement)
Laundry service (contract or MOU)
Cleaning company (contract or MOU)
Funding to purchase and restock items for housing (furniture, electronics, kitchen equipment, linens, etc.)
Gift certificates for food - (grocery store and restaurant coupons)
Transport for infectious patients (to medical appointments, etc.)
Other incentives & enablers
Electronic monitoring/surveillance contract

Leveraging site resources for contact investigation at worksites/groupsites

What is it:
The TB program works with employers and agencies to use their internal resources for post-exposure contact evaluation.  The TB program provides technical oversight of the contact investigation and augments services if needed.  TB screening and evaluation recommendations are provided to the facility management.  Priority locations or contacts are identified.  If occupational medicine or employee health practitioners are involved, the TB program provides forms and consultation for contact evaluation policies/practices.  Recommendations are provided by the TB Program representative to the employer and health providers to: 1) conduct the TB skin testing and medical evaluation of those exposed at the group-sites, 2) collect evaluation outcomes, 3) provide treatment, 4) rule out/report suspect cases.  TB Control collects evaluation outcomes to assist with overall assessment of the event.

Why is this a best practice:
This process leverages the responsibility of employers to maintain a safe and healthy workplace and allows the TB Program to work with households and group-sites that do not have resources for post-exposure follow-up.  

Resources required (staff, time, tools):
Supervising Communicable Disease Investigator
Communicable Disease Investigator

Protocols, forms, templates, documents available? 
Group-site investigation protocol – currently under revision
Group-site assessment form
Group-site TB contact investigation report
Database template for group-site exposures  

(dowloadable documents coming soon)

Contact information for best practice:
Diana Lobo
Supervising Communicable Disease Investigator
(619) 692-8292
diana.lobo@sdcounty.ca.gov
County of San Diego
Department of Health Services
Tuberculosis Control Branch
3851 Rosecrans Street, Suite 128
San Diego, CA 92110-3115

Use of a mobile chest x-ray van to expand case-finding and evaluation services

What is it:
The mobile van provides off-site chest x-ray services at various locations within the county including: 1) regional public health centers with LTBI clinics, 2) the largest downtown homeless shelter, and 3) sites where an exposure has occurred and the use of the van is deemed necessary to facilitate contact screening (e.g., schools, SROs).

Why is it a best practice:
Providing scheduled chest x-ray services to key facilities that do not have chest x-ray capability is, 1) a cost effective alternative to contracting for radiology services, 2) is convenient for the patient, and 3) is valuable for quick detection of TB in a high-risk facility or after a TB exposure.  

Resource required (staff, time, tools):
X-ray van
 Maintenance company for x-ray equipment
Radiology technician
TB Clinician
Clinic Manager
Nurse
Clerical support
Radiologist

Protocols, forms, templates, documents available? 
Chest x-ray procedures
Patient encounter form
Chest x-ray card/consent
IBM card
Patient letter
X-ray calendar
Dictation log
Supplies for van – (x-ray film, x-ray jackets capes, other supplies as needed)
Mileage log
Equipment repair log

(dowloadable documents coming soon)

Contact information for best practice:
Linda Bethel, PHN
Clinic Manager
(619) 692-8890
linda.bethel @ sdcounty.ca.gov
County of San Diego
Department of Health Services
Tuberculosis Control Branch
3851 Rosecrans Street, Suite 128
San Diego, CA 92110-3115

Videophone DOT

What it is:
For selected patients, DOT can be observed over a videophone instead of an in-person visit.   

Why this is a best practice:
This practice can save a considerable amount of staff time and travel costs for health departments.  Given adequate training and supervision, videophone DOT may be provided by a variety of staff including nurses, physicians, and outreach workers. Videophone DOT is a useful option when a patient’s schedule is not compatible with the schedule of the public health worker.  Videophone DOT can shift some DOT responsibilities to clinic or “fixed” staff, allowing field workers to focus on other case management activities.    

Resources required (staff, time tools):

* Videophone
* Phone jack is required in the patient home
* Staff time of: PHN Supervisor, PHN Case Manager, Outreach Worker and Communicable Disease Investigator.  (Work schedules may require additional coverage in the early morning and late afternoon to accommodate patients schedules)
Training
* Staff to assess if a patient is appropriate for video DOT, assign DOT worker, maintain videophone distribution log, generate and maintain DOT records and maintain weekly master schedule of video DOT patients

Protocols, forms, tools, templates, documents available? 

* Videophone Inventory Log
* Policy for Videophone Directly Observed Therapy
* Videophone Sign-out Sheet
* Consent Form
* DOT Record

(dowloadable documents coming soon)

Contact information for best practice:
Linda Bethel, PHN
Clinic Manager
(619) 692-8890
linda.bethel@sdcounty.ca.gov
County of San Diego
Department of Health Services
Tuberculosis Control Branch
3851 Rosecrans Street, Suite 128