1. (a) Correctional facilities, regardless of inmate capacity, shall ensure that:

   1. (1) Each employee, worker, parole/probation officer, or other staff member of the facility who has contact with inmates or detainees receives tuberculosis screening and tuberculosis prevention information (see 20 CAR § 103-101, Definitions); and

   2. (2)

      1. (A) Prior to employment each employee, worker, parole/probation officer, or other staff member of the facility who has contact with inmates or detainees shall:

2. (i) Receive baseline tuberculosis screening; and

   1. (ii) Obtain a certificate of health or documented results of tuberculosis screening as outlined in this part.

      1. (B) No annual follow-up testing requirements are necessary and should be substituted with a symptom screening and tuberculosis prevention education.

   2. (3)

      1. (A) Each inmate residing in any correctional facility for more than fourteen (14) days shall receive:

         1. (i) Baseline tuberculosis screening; and
         2. (ii) Tuberculosis prevention information.
      2. (B) No follow-up testing is required, but symptom screening of positive inmates and tuberculosis education should be provided.

3. (b)

   1. (1) Jails and detention centers housing fifty (50) or more persons shall meet the following requirement.

   2. (2)

      1. (A) Each inmate/detainee of a jail or detention center who is expected to be incarcerated for fourteen (14) days or more will receive tuberculosis screening and tuberculosis prevention information.

      2. (B) See 20 CAR § 103-101, Definitions.

         1. (c) Other correctional facilities shall meet the following requirements:

   3. (1)

      1. (A) Each inmate or detainee of a correctional facility shall receive tuberculosis screening and tuberculosis prevention information.
      2. (B) See 20 CAR § 103-101, Definitions;

   4. (2)

      1. (A) The person having responsibility for the management of a correctional facility shall be responsible for compliance with this part.
      2. (B) Each correctional facility shall be responsible for compliance with this part.
      3. (C) Each correctional facility shall designate an appropriately trained infection control officer who shall be responsible for operating a tuberculosis prevention and control program in the institution.
      4. (D) Multi-institutional systems shall have a qualified coordinator as well as an official at each unit to oversee tuberculosis-control activities throughout the system.

      5. (E)

         1. (i) The correctional facility shall have written procedures outlining the responsibilities of each official, including a copy of each official's job performance plan.
         2. (ii) These procedures shall include provisions for:
4. (a) (a) Surveillance;

5. (b) (b) Containment; and

   1. (c) (c) Assessment.

      1. (iii)
6. (a) (a) Surveillance shall include identification and reporting to the Department of Health of all tuberculin reactors equal to or greater than ten millimeters (10 mm) on inmates or a positive IGRA blood test.

7. (b) (b) The department will be responsible for evaluation and recommendation of appropriate therapy.

   1. (iv) Appropriate containment procedures shall be developed to reduce the chance of transmission of tuberculosis.

      1. (v)
8. (a) (a) Appropriate diagnostic, treatment, prevention, and laboratory services shall be available.

9. (b) (b) Environmental factors conducive to the spread of tuberculosis, such as poor ventilation, shall be corrected.

   1. (c) (c) Persons undergoing treatment or preventive therapy shall be carefully monitored for compliance and to detect drug toxicity to ensure that the recommended course of treatment is completed.

      1. (d) (d) The infection control officer shall notify the department upon discharging any inmate who is receiving medication for tuberculosis and coordinate with department officials to ensure appropriate follow-up of paroled inmates for completion of treatment.

         1. (vi) Procedures shall be developed to ensure that persons in charge of a correctional facility are aware of the responsibility for the surveillance and containment activities within the institution.
         2. (vii) Questions concerning surveillance, containment or assessment, and treatment shall be sought by reference to this part or telephone consultation with the Tuberculosis Program Medical Director or designee.
         3. (viii)
10. (a) (a) The person in charge of the correctional facility will cooperate with the department’s Tuberculosis Program in developing and updating policies, procedures, and record systems for tuberculosis control.

11. (b) (b) The department will provide epidemiologic and management assistance to correctional facilities, including on-site consultation and periodic reevaluation.

    1. (c) (c) Where appropriate, correctional facilities shall cooperate with the department and develop programs of in-service training for correctional facility staff, e.g., to:
    2. (1) (1) Perform, read, and record tuberculin skin tests;
    3. (2) (2) Identify signs and symptoms of tuberculosis;
    4. (3) (3) Initiate and observe therapy;
    5. (4) (4) Monitor for side effects;
    6. (5) (5) Collect diagnostic specimens;
    7. (6) (6) Educate inmates regarding tuberculosis; and

    8. (7) (7) Maintain record systems.

       1. (d) (d) The correctional facility will work with the department regarding the tuberculin testing of nonincarcerated contacts of persons with active tuberculosis identified in these facilities.

          1. (ix)
12. (a) (a) All antituberculosis medication within correctional facilities shall be administered under direct observation by correctional facility staff.

13. (b) (b) Directly observing the swallowing of medication is essential to prevent the development of strains of tuberculosis that are resistant to current effective medications.

    1. (x)
14. (a) (a) Correctional facilities shall work with department staff to arrange continuing therapy for inmates when released while receiving tuberculosis treatment or preventive therapy.

15. (b) (b) Registries shall be maintained with updated medical information on all current tuberculosis cases including those in correctional facilities.

    1. (xi) Correctional facilities shall work with the department officials to:
16. (a) (a) Develop and implement an HIV prevention program;

17. (b) (b) Identify persons practicing high-risk behaviors; and

    1. (c) (c) Counsel such persons in an effort to reduce high-risk behaviors among inmates; and
    2. (3) Prior to commencement of construction of any correctional facility the person or persons responsible for the control and operating of the facility shall furnish a statement that he or she has consulted with the department concerning the architectural design concerning the feasibility of germicidal lights in appropriate areas.

Codification Notes: "HIV" means human immunodeficiency virus. "IGRA" means Interferon-Gamma Release Assays.