Tuberculosis Protocol for Nurses and Doctors
When a detainee presents with symptoms suggestive of TB
the following should be considered:
New transfer or admission?
1.
2.
3.
4.
5.
6.
Are there old notes/results at previous centre?
What are the concerning symptoms?
Are you concerned about the possibility of open active TB?
Is the patient genuine?
How long has he been in this country?
Is it worth liaising with health care at the previous centre
now?
7. What is required to minimise risk to others?
Detainee with a Known Diagnosis
Where a patient with a known diagnosis of open active TB arrives
who has been on treatment for less than two weeks or where
a patient arrives with treatment from the community and doubt
exists about compliance that detainee should not pass reception
and admission should not be allowed to the centre.
Health care should advise Immigration that the person requires
segregated single room accommodation in a centre with such
facility and ongoing medical assessment. Where doubt remains
the duty medical officer should be advised of the situation
Where a detainee with known TB comes from another centre on
treatment and;
 it is confirmed with the previous centre health care staff
that he/she has complied with medication for a minimum
of two weeks
 there is NO concern about possible drug resistance
 having considered the risk factors he/she may be
admitted thereafter to this centre.
Where there has been non- compliance or there is any
question whatsoever of possible drug resistance to treatment
he/she should NOT be admitted to the centre.
Detainee requiring Assessment/Investigation
Where it is required to segregate a detainee pending assessment
or investigation and such appropriate accommodation is not
available within Dungavel. He/She should not be allowed into the
centre.
Immigration should be advised that the individual requires
medical assessment involving isolation/segregation in a centre
with appropriate single room accommodation.
Detainee in Residence
Where a patient already in residence reports symptoms where it
is felt that a differential diagnosis of TB is possible after
consultation with the Medical Officer it may be appropriate to
proceed with investigation. Such investigation can be done while
the detainee remains in segregation at Dungavel if such
accommodation is available. Where such accommodation is not
available it may then be necessary to liaise with the duty
consultant in infectious disease with a view to hospital referral.
Signs and Symptoms of possible TB Infection
1.
2.
3.
4.
5.
6.
7.
8.
9.
Cough
Sputum/ haemoptysis
Chest pain
Shortness of breath
Night sweats
Pyrexia
Weight Loss
Anorexia
General Malaise
Where there is concern:
1.
2.
3.
4.
5.
Isolate/segregate
Sputum samples x 3 on consecutive days to lab
Chest XR if not already available
FBC, U&Es, LFTs, C-reactive protein, ESR
If no facility to isolate liaise with Dr to consider referral to
infectious diseases.
NB: An abnormal CXR is often found with no symptoms but
the reverse is rare.
Pulmonary TB is unlikely in the absence of any radiographic
abnormality.

Where the bloods are normal particularly the CRP, sputums
are negative and CXR negative the diagnosis of open active
pulmonary TB is most unlikely. The patient need then not stay
in isolation as directed by the duty medical officer.

Where it has not been possible to obtain sputums because the
patient does not have productive spit and the bloods and CXR
are normal again open active pulmonary TB is not likely and
the detainee need not stay in further isolation. This should be
directed by the duty medical officer.
DRUG RESISTANCE
There is increasing drug resistance to TB in various parts of the
world. Risk factors to be for developing drug resistant TB
Off and on treatment for possible reactivations
Immunocompromised eg HIV, alcohol abuse, immuno suppressant
therapy
Poor compliance
Prescribing patterns eg monotherapy, adding single drugs to failing
regimes
Diagnosis abroad eg Eastern Europe, Russia
Detainees should on most occasions only require transfer to hospital
for investigation where clinical suspicion remains after baseline
investigations have been carried out or where it has not been
possible to carry out baseline investigations (e.g. lack of facility) or
where it has not been possible to obtain sputum’s etc and some of
the other investigations show abnormality e.g. a concerning report
on CXR, or raised CRP.
Dungavel Isolation/Segregation Facilities
The centre as at April 2006 does not have suitable medical isolation
facilities for specific airborne infectious diseases such as open active
pulmonary TB.
However each individual case will be taken on its merit and where it
is felt appropriate by nursing or medical staff it may be possible to
temporarily segregate an individual pending further assessment and
management.
This can be on a short term basis only.
The location decided upon must be in discussion with duty nurse,
duty medical officer and DCM.
Health care advice to residential staff is paramount and must take
precedence.
All efforts will be made to cause minimum residential disruption
while minimizing risk to other detainees and staff.
Where it is considered that no suitable location is available within
the centre Immigration will be advised of this and further relocation
discussed i.e. another centre or if clinically appropriate hospital.
Examples of possible temporary segregation facilities are top floor
RTU and secure unit.
Rooms opening directly off corridors are NOT appropriate facilities
for airborne diseases.
Actual location will be discussed on an as required basis.