Tuberculosis control
Directive number: QH-HSD-040
Effective date: 14 December 2024
Review date: 14 December 2027
Supersedes: Version 4
On this page:
- Purpose
- Scope
- Principles
- Outcomes
- Mandatory requirements
- Compliance
- Human Rights
- Aboriginal and Torres Strait Islander considerations
- Related or governing legislation, policy and agreements
- Supporting documents
- Business area contact
- Approval and implementation
- Review
- Definitions of terms in this directive
- Version control
Purpose
Tuberculosis (TB) is a nationally notifiable disease. The purpose of this Health Service Directive (HSD) is to ensure a consistent and best practice approach to the control of TB in Queensland through:
- Implementation of standardised clinical management of TB patients.
- Public health strategies for the prevention and control of TB including Multi Drug Resistant-TB (MDR-TB) and Extensively Drug Resistant-TB (XDR-TB) cases in Queensland.
- Appropriate epidemiological surveillance for TB.
Scope
This directive applies to all Hospital and Health Services (HHSs) in Queensland.
Where the term Tuberculosis Control Unit (TBCU) is used this can be a TB service provided in a public health unit, chest clinic, respiratory clinic or other equivalent unit within the HHS.
Principles
- Access: patients have access to a state-wide efficient, effective, and equitable TB service with no out-of-pocket expense to the individual.
- Appropriateness of diagnosis and treatment: patients receive standardised diagnostic and treatment regimens that promote cure whilst minimising TB transmission within the community.
- Effectiveness of treatment: patients receive treatment through a case management model that minimises the risk of drug resistance developing, as well as treatment failure and relapse of disease.
- Surveillance: all TB cases are notified to the Department of Health (DoH) with mandatory data stored in the state-wide Notifiable Conditions System (NoCS) and analysed to ensure the trends and effectiveness of disease control is closely monitored.
- Information management: case management information is collected, stored, and used for clinical, strategic, operational, and service improvement purposes.
- Prevention of disease transmission: systems and processes are implemented and monitored to mitigate the risks of healthcare and community associated infection.
- Communication—appropriate and timely communication between HHSs and the DoH.
- Strategic vision—align activities to The Strategic Plan for control of Tuberculosis in Australia as endorsed by the National Tuberculosis Advisory Committee (NTAC). A new plan will be released during the life of this HSD.
Outcomes
Hospital and Health Services included in the scope of this directive shall achieve the following outcomes:
- All cases of presumed (i.e. clinically diagnosed) and confirmed TB are managed in collaboration with an established TB Control Unit (TBCU) or equivalent unit within the HHS structure, with inpatient guidance by the local facility infection control unit. Public Health Unit support may be requested to assist with contact tracing management.
- Implementation of state-wide standardised diagnosis, treatment, and ongoing management protocols to minimise the risk of drug resistance, treatment failure and/or relapse of disease.
- Adherence to endorsed state and national guidelines for preventing the transmission of TB in healthcare and community settings and to prevent TB in at-risk children through Bacille Calmette-Guérin (BCG) vaccination.
- Notify the DoH of all cases of TB in accordance with the legislative obligations of the Public Health Act 2005 and Public Health Regulation 2018.
- Inform the DoH within one business day of TB cases that pose an increased public health risk, where there is potential for involvement or implication of another jurisdiction, country or other governmental department or non-governmental organisation, or where there is potential for heightened community interest in accordance with the Protocol for Tuberculosis Control.
- Management of TB cases whose behaviour may pose an immediate risk to public health in accordance with the Public Health Act 2005.
Mandatory requirements
Each Hospital and Health Service shall:
- Adhere to the Health Service Directive- Protocol for the Control of Tuberculosis.
- For those HHSs that do not have a TBCU, have in place a formal arrangement with a TBCU for the provision of essential TB services including, but not limited to screening, vaccination and case and contact management.
- Provide timely access to assessment, treatment and follow up, with no out-of-pocket expenses to those with suspected or confirmed TB and to the following persons who require TB screening for exclusion or diagnosis of latent TB infection:
- current and prospective employees in healthcare facilities in Queensland,
- students undertaking placements in Queensland healthcare facilities,
- migrants on health undertakings,
- migrants (and their families) from high-risk TB countries (i.e. incidence of above 40 tuberculosis cases per 100,000 people) and,
- contacts of identified cases.
- Ensure contact tracing and screening meet standards and time stipulations outlined in the Protocol for TB control.
- Develop and maintain a contemporary, evidence-based Infection Control Management Plan (ICMP) that is in accordance with chapter four of the Public Health Act 2005 and the current version of the NHMRC Australian Guidelines for the Prevention and Control of Infection in Health Care.
- Have processes in place to ensure that all prospective workers in health care facilities, including contractors, students and volunteers, whose role may pose a risk of acquisition and/or transmission of TB are assessed and screened appropriately in accordance with the Protocol for the Control of TB and the Health Service Directive No. QH-HSD-047 Vaccine Preventable Disease Screening for Contractors, Students, and Volunteers and supporting protocol QH-HSD-047-1.
- Ensure that all staff who perform Tuberculin Skin Test (TST) or BCG vaccination services have completed the relevant BCG/TST requirements as outlined in the Protocol for the Control of TB.
- Ensure staff administering BCG and/or TST are working within an appropriate, current, and approved legislative framework.
- Develop and maintain a site-specific endorsed vaccine management protocol (VMP) that is in accordance with the National Vaccine Storage Guidelines, Strive for 5, as outlined in the Protocol for TB control.
- Notify the DoH, within five business days of diagnosing all presumed cases of TB (i.e., clinically diagnosed).
- For those HHSs that have a TBCU, they shall ensure:
- the TBCU is staffed by a medical officer with appropriate specialist college qualifications or who is otherwise trained and experienced in TB management. In times when appropriate medical staff are not available, have in place a formal arrangement with another HHS TBCU to ensure adequate medical specialist cover for TB management.
- the TBCU is staffed with appropriately skilled staff to meet the requirements of TB control.
- sufficient staff can access the NoCS.
- the TBCU uses the NoCS for the purpose of receiving case notifications and the storage of the minimum data requirements for each case of TB (refer to the Protocol for Tuberculosis Control section 3.3.2 and 3.3.3).
- if it elects to use an alternative data base for contact management, it must comply with all relevant information management standards and requirements including the Queensland State Archives Health Sector (Clinical Records) Retention and Disposal Schedule and Queensland Government and Queensland Health Information Management policies. It must also comply with providing the numbers of contacts identified including the number under the age of five years and outcomes necessary to meet national reporting requirements.
Compliance
HHSs are responsible for ensuring compliance with this Health Service Directive.
The DoH may check compliance by confirming that HHSs have implemented local policies and processes that comply with the requirements set out in this HSD and the Protocol for Tuberculosis control.
The DoH will supply a self-audit tool to the TBCUs or equivalent units each year for completion. Further requests for evidence of compliance with the requirements of this directive may be requested. In such cases, the DoH will work with HHSs to agree on the information and timeframes within which this is provided.
Human Rights
The human right to privacy and reputation may be limited by this HSD; however, disclosure of confidential patient information in accordance with this HSD, is lawful under the Public Health Act 2005 and the Hospital and Health Boards Act 2011.
Implementation of the requirements set out in this HSD support the human right to health services by promoting improvements of health service delivery and co-ordination for the wider community.
In some circumstances controlled notifiable diseases orders (i.e. an initial examination order, a behavioural order or a detention order) issued under the Public Health Act 2005, are used to assist in the management of TB patients who are non-compliant with their treatment and pose an immediate public health risk. The use of controlled notifiable diseases orders may limit the following human rights:
- protection from torture and cruel, inhuman or degrading treatment (specifically the right to not be subjected to medical treatment without consent) (s 17)
- freedom of movement (s19)
- right to humane treatment when deprived of liberty (s30)
Nothing in this HSD directly limits these human rights. Should it be necessary to issue a controlled notifiable disease order, public service employees must consider human rights and exercise the power in a manner that is compatible with human rights. It is unlawful for a public entity to fail to comply with these obligations.
Aboriginal and Torres Strait Islander considerations
The HHSs must consider any implications for Aboriginal and Torres Strait Islander stakeholders in the management of this HSD.
HHSs must consider the critical importance of addressing TB prevention and management in Aboriginal and Torres Strait Islander populations, particularly in discrete Indigenous communities within the HHS.
This HSD prioritises the prevention of TB through culturally appropriate measures for our First Nations population. Early diagnosis and effective screening are crucial to reducing TB incidence and ensuring prompt treatment of confirmed cases.
Where indicated, HHSs should facilitate community-based screening services to identify TB cases early and initiate treatment without delay.
Collaborative efforts with local Aboriginal Community Controlled Health Organisations and Aboriginal and Torres Strait Islander stakeholders are essential to the success of these initiatives.
Related or governing legislation, policy and agreements
Legislation
- Financial Accountability Act 2009, Qld
- Hospital and Health Boards Act 2011, Qld
- Human Rights Act 2019 (QLD)
- Medicines and Poisons (Medicines) Regulation 2021, Qld
- National Health Securities Act 2007, Cwlth
- Public Health Act 2005 and Public Health Regulation 2018, Qld
- Public Records Act 2002, Qld
- Queensland State Archives Health Sector (Clinical Records) Retention and Disposal Schedule
- Right to Information Act 2009, Qld
- Work Health and Safety Act 2011, Qld
Guidelines
- Queensland Health Clinical Practice Guidelines
- Amikacin use for drug resistant tuberculosis and non-tuberculosis mycobacterial infections.
- Management of contacts of multi-drug resistant tuberculosis
- Management of latent tuberculosis in adults
- Management of latent tuberculosis in children under 14 years
- Treatment of tuberculosis in adults and children
- Treatment of tuberculosis in patients with HIV co-infection
- Treatment of tuberculosis in pregnant women and newborn infants
- Treatment of tuberculosis in renal disease
Supporting documents
- Health Service Directive QH-HSD-047 Vaccine preventable disease screening for contractors, students and volunteers and supporting protocol QH-HSD-047-1.
- Protocol for Tuberculosis Control QH-HSDPTL-040-1:2013.
- Tuberculosis CDNA National Guidelines for Public Health Units.
Business area contact
- Communicable Diseases Management Unit
Email: CDMU@health.qld.gov.au
Approval and implementation
Directive Custodian
Chief Health Officer, Office of the Chief Health Officer.
Approval by Chief Executive
Director General, Queensland Health
Approval date:
12 December 2024
Issued under section 47 of the Hospital and Health Boards Act 2011
Review
This Health Service Directive will be reviewed at least every three years.
Next review due by: 14/12/2027
Definitions of terms used in this directive
Term | Definition / explanation / details | Source |
---|---|---|
ICMP | Infection Control Management Plan (ICMP). Chapter 4 of the Queensland Public Health Act 2005 requires people that perform declared health services, as defined under the Act, to take reasonable precautions and care to minimize the risk of infection to other persons. The Act places a further onus on the owners/operators of health care facilities to have an ICMP for the facility. The ICMP must identify the infection risks at the facility and detail the measures to be taken to prevent or minimise risks. All facilities that perform declared health services as defined under the ACT must have an existing ICMP and review and update it before offering new declared health services. New facilities must have an ICMP prior to providing declared health services. | |
MDR-TB | Multidrug-resistant TB (MDR-TB) is TB resistant to at least isoniazid and rifampicin (and possibly other drugs). MDR-TB treatment is based on susceptibility results and should only be treated by clinicians experienced in managing TB | Centers for Disease Control and Prevention (CDC) |
XDR-TB | Extensively drug-resistant TB (XDR-TB) is a type of MDR-TB that is resistant to isoniazid and rifampicin, plus any fluoroquinolone and at least one of three injectable second line drugs. | Centers for Disease Control and Prevention (CDC) |
TBCU | Tuberculosis Control Unit. This can include a tuberculosis service provided by a public health unit, chest clinic, respiratory clinic or other equivalent unit within the HHS. | Queensland Department of Health |
Health Undertaking | A Health Undertaking is an agreement that is made with the Australian Government to meet health requirements. Health Undertaking are primarily designed to help ensure that visa holders with a significant health condition are followed up by onshore health providers when necessary. | Australian Government, Department of Home Affairs |
No out of pocket expenses | There will be no costs directly charged to the patient, however costs can be indirectly recovered from a third party (such as a health insurer), with the service provider arranging this, and ensuring that no costs are passed onto the patient. |
Queensland Department of Health |
NoCS | The Notifiable Conditions System (NOCS) is the Queensland register for notifiable conditions and supports:
|
Queensland Department of Health |
Version control
Version | Date | Prepared by | Comments |
---|---|---|---|
1.0 | 01/07/2013 |
Communicable Diseases Unit, Chief Health Officer Branch | New document |
2.0 | 11/11/2015 | Communicable Diseases Branch | Reviewed document |
3.0 | 30/11/2018 | Communicable Diseases Branch | Reviewed document |
4.0 | 18/11/ 2021 | Communicable Diseases Branch | Reviewed document |
5.0 | 03/12/2024 | Communicable Diseases Branch | Reviewed document |