N.J. Admin. Code § 8:57-5.3

Current through Register Vol. 52, No. 3, February 3, 2020
Section 8:57-5.3 - Definitions

The following words and terms, as used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise:

"Acid-fast bacilli (AFB)" means organisms that remain stained after being washed in acid solution, may be detected using a microscope, and are then reported as a positive AFB on smear.

1. TB should be considered a possibility when AFB are present on a stained smear, and indicates the likelihood of infectiousness if from a pulmonary source such as, but not limited to, sputum, bronchioalveolar lavage, gastric aspirate, lung tissue, as well as other tissue of the respiratory tract such as the larynx or epiglottis.

1. These classifications are made within 12 months of immigration and these referrals require evaluation of their TB status within 30 days of arrival to prevent potential transmission.

1. DOT is the only method available to reliably determine a patient's adherence to a prescribed treatment regimen.

1. Field services may also include other services the field services provider is trained and equipped to perform (such as, but not limited to, patient interviews, transportation, delinquent investigations).

1. Health care providers include physicians, advanced practice nurses, certified nurse midwives, and/or physician assistants.

1. Threatens to leave an acute care facility against medical advice;

2. Leaves an acute care facility against medical advice;

3. States he or she will not adhere to infection control measures;

4. Does not adhere to infection control measures;

5. Refuses to take anti-tuberculosis medication as prescribed; or

6. Threatens to travel on a public conveyance.

"Index case" means the patient with suspected or confirmed infectious or potentially infectious TB disease or child less than five years of age whose diagnosis results in a source case investigation.

"Infection control measures" means restrictions imposed by a health care provider, nurse case manager, or health officer to protect the public from transmission of tuberculosis from a patient with suspected or confirmed infectious or potentially infectious TB disease.

1. The measures applicable to each patient will vary based upon the circumstances of the individual.

1. A person with latent TB infection does not have an illness nor is he or she infectious.

"Multiple drug resistant tuberculosis (MDR-TB)" means a form of TB disease that is resistant to at least isoniazid and rifampin.

"Nucleic acid amplification test" means polymerase chain reaction (PCR) or Mycobacterium tuberculosis direct (MDT) test.

"Public Health Nurse Case Manager" means the nurse providing public health nurse case management services which include, but are not limited to:

1. Patient education regarding the transmission of TB, how to prevent it, and the importance of keeping appointments for clinical assessments and completing treatment;

2. Facilitating the continuity of care for a patient with suspected or confirmed TB until treatment completion by scheduling diagnostic evaluations in a timely manner, monitoring adherence with prescribed therapy, and intervening as appropriate and necessary to address non-adherence;

3. Assessing adherence with community infection control precautions and intervening as appropriate and necessary to address non-adherence;

4. Coordination of TB care with the care of co-existing medical conditions among multiple medical providers;

5. Assessing the quality of care provided by both public and private health care providers with intervention as necessary;

6. Identification of psycho-social barriers to adherence and treatment completion, including, but not limited to: housing, food, transportation, communication, child care, parenting, incarceration, substance abuse and mental illness and intervention as necessary to promote the continuity of treatment;

7. Coordination of contact or source case investigation and care, including, identification, evaluation and appropriate treatment of all identified contacts;

8. Coordination of investigations for all Class B1 and B2 referrals including location, evaluation, and initiation of appropriate treatment;

9. Coordination of all field services, including provision of DOT as prescribed by a health care provider; and

10. Building and maintaining effective working relationships with infection control professionals at hospitals and private health care providers that identify and report tuberculosis in the designated coverage area.

"Public health warning notice" means a notice issued by a public health nurse case manager to a patient with suspected or confirmed infectious or potentially infectious TB disease, a contact, or class B1 or B2 referral as specified in 8:57-5.10.

"Risk for flight" means any of the following circumstances pertaining to a patient with suspected or confirmed infectious or potentially infectious TB disease posing an immediate or imminent public health risk:

1. Threatens to leave acute care facility against medical advice;

2. Has left acute care facility against medical advice in the past;

3. Threatens not to appear in court;

4. Has failed to appear in court in the past;

5. Is homeless or residency is unstable;

6. Has been lost to medical supervision in the past; or

7. Threatens to travel on a public conveyance.

"Source case investigation" means the process of identification and evaluation of associates of a patient aged 10 years or less with suspected or confirmed TB disease for the purpose of finding the source of the child's disease and interrupting additional transmission.

"Suspected or confirmed infectious or potentially infectious TB disease" means one or more of the following:

1. A patient with a smear positive for AFB and/or nucleic acid amplification test positive for M.tb and/or a culture positive for M.tb or M.tb complex;

i. This applies only to specimens from sputum, brochioalveolar lavage, gastric aspirate, lung tissue or other tissue of the respiratory tract such as the larynx or epiglottis;

2. A patient with a chest radiograph, computed tomography scan, or clinical findings indicative of pulmonary tuberculosis sufficient to prescribe treatment with anti-tuberculosis medications;

3. A patient whose chest radiograph or respiratory symptoms improve while taking anti-tuberculosis medication; or

4. A patient with respiratory symptoms indicative of pulmonary tuberculosis until a diagnostic evaluation is completed to rule out TB as a cause of these symptoms.

1. A patient meeting the definition of suspected or confirmed infectious or potentially infectious TB disease;

2. A patient with a smear positive for AFB and/or nucleic acid amplification test positive for M. tuberculosis and/or a culture positive for M. tuberculosis or M. tuberculosis complex from a location outside the respiratory tract;

3. A patient with extra-pulmonary clinical findings indicative of tuberculosis sufficient to prescribe treatment with anti-tuberculosis medications;

4. A patient whose extra-pulmonary symptoms improve on anti-tuberculosis medications; or

5. A patient with symptoms indicative of extra-pulmonary tuberculosis until a diagnostic evaluation is completed to rule-out TB as the cause of these symptoms.

"Vulnerable population" means persons who are vulnerable to rapid progression to TB disease once infected including, but not limited to, persons with the following conditions or on the following treatments: HIV infection, corticosteroid therapy, tumor necrosis factor (TNF) alpha blocker therapy, cancer chemotherapy, end-stage renal disease, cancer of the head or neck, or children under the age of five years.

N.J. Admin. Code § 8:57-5.3