New Jersey Administrative Code › Title 8 - HEALTH › Chapter 57 - COMMUNICABLE DISEASES › Subchapter 5 - MANAGEMENT OF TUBERCULOSIS › Section 8:57-5.3 - Definitions

Current through Register Vol. 56, No. 14, July 15, 2024
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.
The
				  adopted version of this section 56 N.J.R. 213(a), effective
				  1/3/2024 is not yet
				  available