Tuberculosis control protocol

Protocol number: QH-HSDPTL-040-1

Effective date: 14 December 2024

Review date:  14 December 2027

Supersedes: version 4

On this page:

1. Purpose
2. Scope
3. Process for the control of tuberculosis in Queensland: roles and responsibilities
4. Human Rights
5. Aboriginal and Torres Strait Islander considerations
6. Supporting and related documents
7. Authorising Health Service Directive
8. Definition of terms
9. Approval and implementation
10. Version control

1. Purpose

This Protocol describes the mandatory steps for the control of tuberculosis (TB) in Queensland. The term TB refers to active disease. Where latent TB infection is being used, it will be made explicit.

2. Scope

This Protocol 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.

3. Process for the control of tuberculosis in Queensland: roles and responsibilities.

3.1 Queensland Department of Health

The Communicable Diseases Branch within the Queensland Department of Health (DoH) is responsible for strategic oversight and systems support for TB control in Queensland HHSs.

This is facilitated by:

• strategic leadership to support policy planning, development, and implementation of effective TB control that is in alignment with the current National Tuberculosis Advisory Committee (NTAC) Strategic Plan for TB control in Australia. A new plan will be released during the life of this protocol.
• coordination, where appropriate, of expert advice forums to support clinical and public health management of TB
• coordination of state-wide programs and where appropriate, peer network forums to support information sharing, capacity building and effective best practice management of TB
• monitoring and analysing state-wide surveillance data to inform disease trends for TB control and strategic planning in collaboration with the Public Health Intelligence Branch.
• monitoring State and Commonwealth regulatory and legislative obligations that are relevant to TB control services
• facilitating access to educational resources and requirements that support attainment of knowledge and skills for registered nurses working in TB control including:
  • public health management of TB and Bacille Calmette-Guerin (BCG) vaccination and tuberculin skin testing (TST)
  • contact tracing officer certification
  • custodianship and maintenance of a contact tracing officer register
• contributing to quality assurance initiatives and where practicable, research that contributes to the continued delivery of evidence-based clinical practice, including methodologies and frameworks used to prevent, identify, manage, or minimise the spread of infection
• monitoring issues impacting on the ability of TBCUs to perform their role.

3.2 Hospital and Health Services

HHSs shall:

• ensure clinical and public health management of TB cases and contacts is in accordance with published relevant state and national guidelines.
• ensure diagnosis and treatment of latent TB infection in those at risk of progression to active TB is in accordance with Queensland Health guidelines.
• ensure all TB diagnostic services and treatment have no out-of-pocket expenses to the patient.
• ensure all new cases of TB are notified to the Department of Health (DoH) as per the Public Health Act 2005 and Public Health Regulation 2018. This includes notifying cases where, in the absence of laboratory confirmation, a clinical diagnosis of TB is made.
• ensure surveillance data are completed as soon as possible directly into the Notifiable Conditions System (NoCS). These data are required to meet the mandatory reporting requirements of the National Notifiable Diseases Surveillance System (NNDSS) and to facilitate TB reporting for Queensland.
• ensure all TB patients are assessed and followed up to the completion of therapy and have post-treatment follow up as outlined in the Treatment of Tuberculosis in Adults and Children Guideline, by a medical officer with appropriate specialist college or equivalent qualifications who is trained and experienced in TB management.
• ensure 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 as per the Queensland Health TB risk assessment form.
• provide reporting on request to the DoH regarding compliance with the requirements of the TB HSD and/or Protocol.
• monitor issues impacting on the ability of TBCUs to perform their role.

3.3 Tuberculosis Control Units within Hospital and Health Services

3.3.1 Urgent advice to the Department of Health

The DoH are to be informed as soon as possible within one business day via the CDMU@health.qld.gov.au email account where any of the following apply:

• there is suspicion or confirmation of a case of multidrug-resistant TB (MDR-TB) or extensively drug-resistant TB (XDR-TB)
• there are more than 30 contacts of an active TB case
• any cases of healthcare associated transmission of TB
• where a pattern of TB cases suggests a transmission cluster
• where contact tracing is to be conducted in an institution or organisation
• where there is potential for a level of community interest that will require a media holding statement or release of any information to other media sources by the HHS
• where a case spent eight or more hours in an aircraft
• where there is a potential or actual public health risk requiring involvement of, or having implications for, another jurisdiction, country or other governmental department or non-governmental organisation
• any factors that may result in significant delay in implementing appropriate public health management of TB.

TBCUs are to provide the DoH with an update and/or outcome report regarding the above notifications, if requested.

3.3.2 Clinical information management

Minimum data requirements for each TB case are entered and stored in NoCS. This minimum data requirement is defined within the NoCS system and is to be entered directly by TBCU staff.

The NoCS provides utility for contact management and although it is not mandatory for HHSs, it is strongly recommended it be used for this purpose. NoCS collects a summary of contact numbers which is now required to report to the NTAC for laboratory confirmed pulmonary TB cases.

Surveillance data for TB submitted to the DoH are stored in NoCS for state-wide reporting and provision of data to the NNDSS under the National Health Securities Act 2007.

Clinical record management must meet the requirements of the Health Sector (Clinical Records) Retention and Disposal Schedule, the Information Privacy Act 2009 (Qld) and the Public Records Act 2002 (Qld).

3.3.3 TB control surveillance

TBCUs hold responsibility for the collection and submission of TB data. The DoH is responsible for monitoring data quality, maintaining the data collection in NoCS and facilitating appropriate local and national reporting. Laboratory confirmed diagnoses of TB are sent electronically into NoCS. Clinical diagnoses of TB are manually generated in NoCS following submission of notification details by TBCUs to data services. Notifications can also be submitted by using the Notifiable Conditions Report Form PHA s70. Notifications of clinical diagnoses of TB should be received by DOH within 5 business days of diagnosis.

Once a TB notification has been generated, TBCUs are required to enter TB surveillance data into NoCS to meet national reporting requirements. This data is requested to be completed as soon as possible and within 14 days of diagnosis of all cases.

The collection of treatment outcome data should be entered directly into NoCS. This data is requested within 14 days of the end of treatment or the end of the TBCU’s management of patients (that transfer out of their care).

From time-to-time DoH may require additional data including data as requested by the NTAC, a subcommittee of the Communicable Disease Network Australia (CDNA).

3.3.4 Visa health assessments

TBCUs are required to:

Perform triaging and provide TB diagnostic and management services to all clients that fall within their geographical region who are referred to them as part of the Department of Home Affairs (DHA) health undertaking and deferral processes.

• provide TB diagnostic services to meet visa requirements, and where appropriate, recoup these costs from a third party such as a private health insurer. The HHS must ensure no out-of-pocket expenses to the client occurs.
• provide a clinic attendance report to the DHA, via the Health Assessment Portal (HAP) or email to Bupa Medical Visa Services.
• ensure the timely notification of all 'failures to present' of health Undertaking clients to the appropriate referring entity (Department of Home Affairs or Bupa Medical Visa Services).

3.3.5 Case management

Required public health response is aligned with the Tuberculosis – CDNA Guidelines for Public Health Units.

Response times

Prompt response is required when a new diagnosis of TB is made to ensure the best possible outcome for the patient and prevent transmission in healthcare facilities and the community by early implementation of therapy and appropriate infection prevention and control practices.

For TB cases where sputum/or another respiratory tract sample is acid fast bacillus (AFB) smear positive:

• ensure appropriate transmission-based precautions have been implemented within 1 day of notification, noting that airborne precautions should be implemented in a healthcare setting upon suspicion of pulmonary TB. Please refer to local facility transmission-based precautions procedure.
• commence follow up of the case within 1 working day of notification to the clinician, aiming to commence treatment within 3 working days of notification to the TB control unit, or sooner depending on the acuity of the illness.

For smear negative TB cases and extra pulmonary TB cases where TB is confirmed by PCR and/or culture:

• ensure appropriate transmission-based precautions have been implemented as per local facility transmission-based precautions procedure.
• commence follow up of the case within 3 working days, aiming to commence treatment within 7 days of diagnosis notification.

Where these response times cannot be met by TBCUs for legitimate reasons, response should be as soon as practical. Legitimate reasons include:

• patient is in a remote location distant to a treatment centre
• non-adherence by the patient to follow up requests
• drug resistance is confirmed or suspected and, where no harm will eventuate, treatment is delayed based on the judgment of the treating medical officer, pending further drug susceptibility data.

The use of controlled notifiable conditions orders (i.e. initial examination, behavioural and detention) under the Public Health Act 2005 can assist in the management of TB patients that are non-compliant with their treatment and pose an immediate public health risk. However, controlled notifiable conditions orders should only be used when all efforts to gain voluntary compliance, such as working collaboratively with non-government agencies in the community and the use of incentives and enablers have been exhausted.

Case management key principles

Each TB patient, regardless of public or private status, must have an allocated case nurse from a TBCU. The case nurse role performs the following functions:

• interviews the patient as soon as practical to determine information that will inform public health actions (see 3.3.12 Contact Tracing)
• provides a supportive partnership and advocacy role between the patient and treating medical officer to deliver quality, timely, and client-focused management
• provides health education and treatment support to facilitate adherence
• provides early identification of adverse effects of therapy
• facilitates access to HHS based services which may be required to address financial or social problems
• In collaboration with the treating Doctor, ensures a rapid molecular laboratory test has been performed to determine rifampicin susceptibility status
• In collaboration with the treating Doctor, ensure TB patients are tested for co-infection with human immunodeficiency virus (HIV) with an appropriate pre-test and post-test discussion and subsequent management as per the Queensland Health Treatment of tuberculosis in patients with HIV co-infection guideline (see section 3.3.8)

3.3.6 Management of TB in Healthcare Settings and the Community

Clinicians managing patients in HHS facilities should ensure that, upon clinical suspicion of pulmonary TB, airborne precautions are implemented immediately with inpatients accommodated in a negative pressure isolation room. Refer to local facility procedures for guidance on airborne precaution management.

Young children (particularly under 5 years of age) are very rarely infectious; hence immediate implementation of airborne precautions is not necessary in this group but should be considered within 24 hours. If not already in place airborne precautions should be implemented upon notification of sputum smear positive pulmonary TB.

Patients with TB- HIV co-infection may not have typical symptoms. Pulmonary TB should be considered in the differential diagnosis of HIV positive patients who are at higher risk of TB (e.g. from higher burden TB countries) with respiratory symptoms or undiagnosed systemic illness.

Clinicians managing patients with a clinical suspicion and/or confirmation of pulmonary TB who are in the community (e.g. home isolation) must ensure the patient and family are provided with appropriate education and counselling about minimising the risk of transmission of infection; cough hygiene, avoiding new contacts and restricting movements away from home.

The patient should be isolated until assessed as being at minimal risk of transmitting infection.

For MDR-TB or complex cases where there is uncertainty regarding the level of infectiousness, an opinion may be sought from the Tuberculosis Expert Advisory Group (TEAG) (section 3.3.7).

Adequate social support and supervised therapy should be provided to patients in the home environment to increase adherence and compliance with infection prevention and control and treatment requirements.

For further detail refer to the Infection Control Guidelines for the management of patients with suspected or confirmed pulmonary tuberculosis in healthcare settings.

3.3.7 Tuberculosis Expert Advisory Group

The Tuberculosis Expert Advisory Group (TEAG) exists to provide expert advice on the management of complex TB cases to ensure that such cases are peer reviewed and best practice principles are recommended. If the treating team does not implement TEAG recommendations, feedback including the rationale for deviation from TEAG recommendations is to be provided to the TEAG via the Chair or via the CDMU@health.qld.gov.au email account.

HHSs are required to alert TEAG via the CDMU@health.qld.gov.au email account where there is:

• a new case of rifampicin resistance (includes MDR-TB and XDR-TB)
• where it is proposed that the Public Health Act 2005 be used to make an application for either a behavioural order or a detention order for a patient that poses an immediate risk to public health.

HHSs are encouraged to refer clinical cases where there is:

• complex drug intolerance or other drug resistance
• complex co-morbidities including a new case of TB-HIV coinfection.
• complex cases (other complex clinical or social factors impacting treatment)
• paediatric diagnosis (cases or contacts)
• where published evidence is lacking to guide clinical practice (including determination of infectious state)
  • failure of sputum cultures to convert to negative following two months of therapy for drug-susceptible TB.

For further information contact the TEAG via CDMU@health.qld.gov.au.

3.3.8 Principles of treatment

Queensland Health publishes guidelines for the management of tuberculosis. HHS clinicians should follow these guidelines in most circumstances. Where a treatment related issue is not covered by the relevant guideline or where a treating medical officer wishes to pursue treatment contrary to the guideline, referral of the issue to TEAG is strongly encouraged.

The guidelines currently endorsed by TEAG are:

• Treatment of tuberculosis in adults and children
• Management of latent tuberculosis in adults
• Management of latent tuberculosis in children under 14 years
• Treatment of tuberculosis in patients with HIV co-infection
• Management of tuberculosis in pregnant women and newborn infants
• Treatment of tuberculosis in renal disease in adults
• Management of contacts of multi-drug resistant tuberculosis
• Guideline for the use of amikacin for drug resistant tuberculosis and non-tuberculosis mycobacterial infections in Queensland

Clinicians must identify and manage barriers to successful treatment adherence including ensuring diagnosis and treatment is free of cost to the patient and ensuring directly or video observed therapy (DOT/VOT) or other aids to adherence are provided as required.

TB diagnostic services and treatment may be charged to a third party i.e., private health insurer. However, the HHS must ensure there will be no out of pocket expenses to the client.

Microbiological monitoring of treatment:

• For pulmonary TB, sputum AFB, smear and culture should be tested at the end of the intensive phase (2 months) for drug sensitive TB.
• If culture is still positive for non-MDR-TB, monthly cultures of at least two sputa collected should be performed until culture conversion is documented.
• For MDR-TB cases, monthly sputum monitoring should be performed.
• Wherever possible, sputa should be tested at the end of treatment to document culture negativity, consistent with the World Health Organization definition of cure.

Failure to achieve such outcomes may be an indication of drug resistance or identify patients (even with drug susceptible disease) who would benefit from a longer duration of therapy.

Treatment records need to be made readily available to relevant clinicians, including the TEAG as required for patient management.

3.3.9 Directly observed therapy and video observed therapy

Decisions regarding the use and mode of Directly Observed Therapy DOT and/ or Video Observed Therapy (VOT) should be based on local and individual patient circumstances. DOT/VOT is strongly encouraged for patients at high risk of suboptimal therapy due to the following:

• any form of rifampicin resistance including MDR-TB and XDR-TB
• patients on three-times per week therapy* [1]
• any patient who has demonstrated they do not have capability to self-administer or are not able to maintain compliance with the recommended medication regimen
• smear positive cavitary disease
• anyone with a history of previous TB treatment.

The decision whether to use DOT or VOT or a combination, and whether it should be delivered in the community or health clinic, should be made in consultation with the patient, treating doctor, TBCU case nurse, and other relevant HHS staff as required.

For additional information refer to the Tuberculosis – CDNA National Guidelines for Public Health Units.

3.3.10 Patient travel and/or transfer

The TB clinician must inform the patient of all relevant infection control, public health measures and/or continuity of care requirements, this will include any implications for travel or a requirement to refer to another TB control program.

If a patient with active TB or incompletely treated active TB and who may pose a public health risk, leaves the state or country without providing notice, the DoH will act on the advice of the TBCU and facilitate appropriate communication to the National Incident Centre or, alert other jurisdictional counterparts as appropriate.

It is the responsibility of the case management team to notify the CDB by email to CDMU@health.qld.gov.au as soon as possible within one business day to ensure timely and appropriate public health management.

In the Treaty areas of the Torres Strait Islands and Papua New Guinea, patient movement will be managed in accordance with Torres and Cape HHS endorsed procedures.

3.3.11 Contact management

Contact management is to be undertaken by TBCUs in accordance with the Tuberculosis – CDNA National Guidelines for Public Health Units.

Contact tracing assessment for contacts of sputum smear-positive, pulmonary TB notifications should begin within seven working days of receipt of notification, with investigation of household contacts to commence as soon as possible. The number of household contacts for sputum smear positive, pulmonary TB cases should be entered into NoCS (contact management) to enable reporting to NTAC.

All other cases should be followed up within 14 days of receipt of notification.

3.3.12 Contact tracing

The aim of contact tracing is to identify the source case, detect additional active cases and potential infections among contacts, especially vulnerable young children (aged <5 years), and counsel and refer individuals with latent TB infection for assessment and preventive therapy.

Contact tracing activities must only be undertaken by staff who have been appointed as a contact tracing officer (CTO) under the Public Health Act 2005.

Anyone seeking to be appointed as a Contract Tracing Officer (CTO) should refer to the Contact Tracing Guideline and complete the application for appointment form located on QHEPS in the Public Health Operational and Regulatory toolbox.

Eligible applicants meeting the requirements of the Public Health Act 2005 will be assessed and subsequently appointed by the delegate of the Chief Executive, if appropriate. Eligibility is based on completion of the assessment package hosted by the Health Protection and Regulation Branch (HPRB), and endorsement by the designated supervisor. Upon issuing the identification card, the individual's name will be added to the CTO register, maintained by the HPRB.

Where the treating medical officer/s are not designated contact tracing officers, but have expertise in TB, they must consult with the case management team within a TBCU to determine the infectivity of a TB case and assist as required with contact tracing.

While performing the interview as part of contact tracing, the CTO must:

• review the case to determine the degree and duration of infectiousness, noting site of disease, AFB sputum smear status for pulmonary TB and symptom onset date
• assess environmental and behavioural factors that may modify the likelihood of transmission
• promptly identify persons who have had significant close or prolonged contact with the person diagnosed with, or under suspicion of having TB and assess whether any such contacts have enhanced vulnerability to TB disease including children under 5 years of age and contacts who are immunocompromised
• obtain a list of close household contacts and close other contacts and invite them for screening within seven days of diagnosis or as soon as practical after this. Where deviations from these timelines are made, the reasons should be clearly documented
• complete a nursing interview using the patient diagnosed with active TB form, enter data into the TBCU's database and attach to the patient file of the index case in NoCS
• attend to 'concentric screening' according to a risk assessment where large numbers of contacts are involved.

The case management nurse must then discuss the findings of the interview and contact tracing with a senior TB clinician to plan the screening management. The senior TB clinician is to determine if extended screening is deemed necessary.

3.3.13 Contact screening

TBCUs are responsible for the management of contact screening for individuals residing within their HHS, noting existing formal arrangements. Where contact screening involves a health care facility, the relevant infection prevention and control service works closely with the TBCU and is required to determine who has been in contact with the index case and ensure appropriate follow-up.

Where a contact resides in another HHS, the originating TBCU will forward information to the relevant unit (via email and follow up phone call) who will undertake screening and provide test results and or screening outcomes back to the originating unit.  Where a TBCU  does not have resources to manage a large screening process, the TBCU should immediately notify the HHS executive to seek the required resources.

DoH will facilitate interjurisdictional referral including the provision of TBCU key contact details as provided by the relevant TBCU where contact screening is required for persons in other State or Territory jurisdictions or countries. Sufficient case and contact data to inform appropriate contact management must be provided by the TBCU to the DoH to inform the relevant notification.

The case management team must determine (and communicate to the DoH) if secondary transmission has been identified through identification of clusters or reviewing epidemiological data.

TBCUs are responsible for ensuring appropriate post-screening follow-up and treatment occurs.

The case management nurse must ensure that accurate, up-to-date electronic records are kept of identified contacts and their individual screening outcomes. NoCS collects a summary of contact numbers which is now required to report to NTAC for laboratory confirmed pulmonary TB cases.

3.3.14 Non-attendance of contact screening

TBCUs must ensure contact tracing activities, including follow up for non-attendance, are conducted in a culturally and linguistically appropriate manner.

In the instances where the risk of transmission of TB is high and contacts fail to present for their screening appointment TBCU business processes must include a minimum of two documented additional invitations, appropriately supported both culturally and linguistically (e.g. using appropriate interpreters, refugee support agencies, and Indigenous liaison officers to encourage the person to attend).

If the contact continues to fail to attend, a senior TB clinician (nursing or medical) must be consulted and a record of all attempts and outcomes documented.

3.3.15 Airline contact tracing

Generally, contact tracing among airline passengers is only necessary if the index case was, or thought to be smear positive at the time of the flight, and where the total flight time (inclusive of all time in the aircraft, during flight and on tarmac) was eight hours or more.

Screening must be offered to passengers who were seated in the same row and two rows before and two rows after (inclusive) of the index case.  If the index case is a member of the aeroplane crew, passengers are unlikely to be at increased risk of infection but crew members should be assessed using the same principles of contact management as outlined in the Tuberculosis – CDNA National Guidelines for Public Health Units.

3.3.16 Bacille Calmette-Guerin vaccination and tuberculin skin testing

Administration of Bacille Calmette-Guerin (BCG) and Tuberculin Skin Testing (TST) must only be undertaken by appropriately trained staff with the relevant authority to administer.

Successful completion of theoretical training and subsequent successful assessment of clinical competency as detailed below is a requirement for registered nurses/ midwives to administer BCG or TST.

Currently clinical competency assessment provided by TBCUs is restricted primarily to nurses working in, or intending to work in, TBCUs but may include other registered nurses/ midwives that support the TB program, as determined by their respective HHS.

A BCG and TST e-learning theoretical training package has been developed by the DoH and is comprised of online learning modules and mini-examinations. Successful completion of the online theoretical component is required prior to the health care worker completing all relevant practical clinical competency assessments, (administration of BCG or TST) as determined by and arranged with a TBCU.

The HCW must undergo reassessment at defined periods, as determined by the relevant TBCU in partnership with the HHSs, to remain clinically competent to perform TSTs and/or BCGs. The Credentialing and defining the scope of clinical practice HSD may apply as determined by the HHS.

All TBCUs must have a current vaccine management protocol (VMP) endorsed by the relevant Public Health Unit in accordance with the National Vaccine Storage Guidelines “Strive for 5”. HHSs will have in place a process to determine that all staff involved in vaccine management demonstrate appropriate competency as outlined in the VMP.

3.3.17 Laboratory diagnosis

TB is notifiable upon detection of Mycobacterium tuberculosis (M. tuberculosis) complex DNA by nucleic acid amplification (NAA) technology, isolation of M. tuberculosis complex by culture or by clinical criteria outlined elsewhere.

BCG strain M. bovis is an exception to this requirement whereas other members of the M. tuberculosis complex are notifiable. The finding of AFB from a clinical sample is also notifiable, but in itself does not distinguish TB from non-tuberculous mycobacteria.

It is essential all efforts are made to establish a microbiological diagnosis. This confirms that the illness is due to TB and provides an organism for drug susceptibility testing. This is essential for ensuring correct antimicrobial treatment and enables genetic typing to assist in epidemiological investigations and public health control of TB transmission.

The Queensland Mycobacterium Reference Laboratory (Pathology Queensland) is the reference laboratory for all HHSs and receives all referred mycobacterial tuberculosis (MTB) isolates from Queensland based private pathology providers.

New smear positive respiratory samples will be tested with the GeneXpert MTB/RIF Ultra assay which is a NAA test which detects both the presence of M. tuberculosis and the presence of rifampicin resistance. This test can be clinician requested for AFB smear negative samples where the clinical suspicion of TB+/- drug resistance to rifampicin is high. GeneXpert or alternative NAA detection can be performed on non-respiratory samples depending on the nature of the sample - such testing should be discussed with the laboratory (07 3646 0032).

3.3.18 Workers and students in health care facilities risk assessment

HHSs shall have processes in place to ensure 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 using the Queensland Health TB risk assessment form. HHSs may have processes in addition to the current QH TB risk assessment criteria.

For both workers and HHSs to comply with provisions of the Work Health and Safety Act 2011 (WHS Act), workers are required to undertake and adhere to the TB risk assessment process.

Other areas of Queensland Health that fall outside of the HHSs, such as Pathology Queensland and Queensland Public Health and Scientific Services (QPHaSS), are strongly recommended to assess clinical risk and implement the same principles and processes to minimise the risk of transmission of TB as appropriate.

The risk assessment form identifies those workers who require further assessment and medical testing for the presence of latent or active TB. Those who are from or have travelled to high-risk TB countries for three months or longer (cumulative) are at the greatest risk for developing TB.

The TB risk assessment form must be completed prior to commencement of work or clinical placement with further screening, if required, to occur soon after. Where the assessment determines that a worker has risk factors, they will be advised of the required follow up.

Workers and students should not have to be retested unless there is a change to their risk stratification since they were last tested as described in the TB risk assessment form and matrix.

The QH TB risk assessment form and supporting documents are available on the Queensland Health Tuberculosis website.

HHSs must have an arrangement in place with tertiary institutions to ensure that before accepting a student for a clinical placement, the student has undergone this risk assessment.

It is the responsibility of each HHS to securely and retrievably store records of risk assessments and referrals for Queensland Health employees.

BCG vaccination is not routinely recommended for any health care workers or students on clinical placement.

For definitions of contractors, students and volunteers please refer to the HSD Protocol for vaccine preventable disease screening for contactors, students, and volunteers.

For definitions of workers please see HR policy B1 Recruitment and Selection.

4. Human Rights

The human right to privacy and reputation may be limited by this protocol; however, disclosure of confidential patient information in accordance with this protocol, is lawful under the Public Health Act 2005 and the Hospital and Health Boards Act 2005.

Implementation of the requirements set out in this protocol 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 protocol 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.

5. Aboriginal and Torres Strait Islander considerations

The HHSs must consider any implications for Aboriginal and Torres Strait Islander stakeholders in the management of this protocol.

HHS 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 directive prioritises the prevention of TB through culturally appropriate measures for our First Nation population. Early diagnosis and effective screening are crucial to reducing TB incidence and ensuring prompt treatment of confirmed cases and vaccination.

Where indicated, HHS 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.

6. Supporting and related documents

6.1 Legislation

• Financial Accountability Act 2009 (Qld)
• Medicines and Poisons Act 2019 (Qld)
• Medicines and Poisons (Medicines) Regulation 2021
• Hospital and Health Boards Act 2011 (Qld)
• Human Rights Act 2019 (QLD)
• National Health Securities Act 2007 (Cwlth)
• Public Health Act 2005 (Qld)  
• Public Health Regulation 2018 (Qld)
• Right to Information Act 2009 (Qld)
• Work Health and Safety Act 2011 (Qld)
• Queensland State Archives Health Sector (Clinical Records) Retention and Disposal Schedule
• Information Privacy Act 2009 (Qld)
• Public Records Act 2002 (Qld)

6.2 Queensland Health Guidelines

• Treatment of TB in adults and children
• Management of latent tuberculosis in adults
• Management of latent tuberculosis in children under 14 years
• Treatment of tuberculosis in patients with HIV co-infection
• Management of tuberculosis in pregnant women and newborn infants
• Treatment of tuberculosis in renal disease in adults
• Management of contacts of multi-drug resistant tuberculosis
• Guideline for the use of amikacin for drug resistant tuberculosis and non-tuberculosis mycobacterial infections in Queensland

6.3 National Tuberculosis Advisory Committee guidelines and position statements

• The Strategic Plan for Control of Tuberculosis in Australia,2021 - 2025:
• Essential components of a tuberculosis control programme within Australia
• The BCG vaccine: information and recommendations for use in Australia
• Management of tuberculosis risk in healthcare workers in Australia
• Position statement on interferon-y release essays for the detection of latent tuberculosis infection
• National position statement for the management of latent tuberculosis infection
• Infection control guidelines for the management of patients with suspected or confirmed pulmonary tuberculosis in healthcare settings
• Tuberculosis - CDNA National Guidelines for the Public Health Units
• The Australian Immunisation Handbook

6.4 Other resources

• Public Health Operational and Regulatory toolbox – Module 10C-Contact Tracing Officer
• Application for CTO appointment form
• Health Service Directive- Credentialing and defining the scope of clinical practice
• Adverse Event Following Immunisation Reporting Form
• Notifiable Conditions Report

Torres and Cape Hospital and Health Service: Management of Papua New Guinea traditional inhabitants presenting to Queensland Health facilities within the Australian islands of the Torres Strait Protected Zone

7. Authorising Health Service Directive

• Health Service Directive – Tuberculosis Control

8. Definition of terms

9. Approval and implementation

Protocol custodian

Chief Health Officer, Office of the Chief Health Officer.

Approval by Chief Executive

Director General, Queensland Health

Approval date: 12/12/2024

Effective from: 14/12/2024

10. Version control

11. Footnotes

1. For three times per week therapy, one or two defaults from attendance for the DOT dose(s) amounts to a loss of efficacy disproportionate to the number of dosages missed. Even a single failure from attendance must be followed up to investigate the reason for non-adherence and identify where other strategies or community support services may be of benefit.