HNY Policy and Pathway Repository - Humber

Referral criteria for Community TB Nursing Service:

• New entrant and inclusion health group TB screening. Please do not assume that screening has been done especially those who have transferred in from another area.
  • New entrants are defined as people who have entered the UK in the past 5 years and have originated from a country of high TB incidence as recorded by the WHO prevalence profile which can be accessed at: TB profile
  • Inclusion health Groups (IHG’s) include, but are not limited to:
  • people experiencing homelessness
  • vulnerable migrants (including asylum seekers, refugees and undocumented migrants)
  • people in contact with the CJS (criminal justice system)
  • sex workers
  • Gypsy, Roma, Traveller (GRT) groups
  • victims of modern slavery
  • people with drug and alcohol dependence

• TB contact screening: Screening for individuals who have had contact with an active case of pulmonary or laryngeal TB. Contact with cases of extrapulmonary TB do not usually require screening however, this will be assessed on a case by case basis. Please refer for triage
• Diagnostic TB screening: carried out on patients who are being considered for biologic, anti-tumour necrosis factor (anti-TNF) and Janus Kinase (JAK) therapies. LTB infection risk is assessed prior to inducing pharmacological immunosuppression, to mitigate the risk of future TB activation if the patient has unknown LTB infection. Please note that we will only accept referrals for diagnostic screening from a medical consultant or specialist nurse.
• Missed neonatal BCG vaccine: we can provide BCG vaccine to children under the age of 16 years in accordance with Chapter 32 of the Green Book (available at: Greenbook chapter 32 - tuberculosis ):
  • all infants (aged 0 to 12 months) with a parent or grandparent who was born in a country where the annual incidence of TB is 40/100,000 or greater
  • all infants (aged 0 to 12 months) living in areas of the UK where the annual incidence of TB is 40/100,000 or greater
  • previously unvaccinated children aged one to five years with a parent or grandparent who was born in a country where the annual incidence of TB is 40/100,000 or greater. These children should be identified at suitable opportunities, and can normally be vaccinated without tuberculin testing
  • previously unvaccinated, tuberculin-negative children aged from six to under 16 years of age with a parent or grandparent who was born in a country where the annual incidence of TB is 40/100,000 or greater. These children should be identified at suitable opportunities, tuberculin tested and vaccinated if negative (see section on tuberculin testing prior to BCG vaccination)
  • previously unvaccinated tuberculin-negative individuals under 16 years of age household or equivalent close contacts of cases of sputum smear-positive pulmonary or laryngeal TB (following recommended contact management advice – see National Institute for Health and Clinical Excellence (NICE), 2016)
  • previously unvaccinated, tuberculin-negative individuals under 16 years of age who were born in or who have lived for a prolonged period (at least three months) in a country with an annual TB incidence of 40/100,000 or greater
• TB related enquiries and advice

Newly registered patients moving into the local area with known latent or active TB infection.

Patients exhibiting signs and symptoms of active pulmonary TB:

• Persistent cough that lasts 3 weeks or longer and gets progressively worse (with or without haemoptysis)
• Unexplained weight loss
• fever and heavy night sweats
• a general and unusual sense of tiredness and being unwell.
• After pulmonary TB, lymph node TB is the second most common form of TB infection and a cough may be absent in this cohort.
• Be suspicious for TB if the patient has the above symptoms and any risk factors associated with previous TB contact e.g: originates from country of high incidence, inclusion health groups and/or history of TB contact.

Where TB infection is clinically suspected, obtain x 3 sputum samples for Acid Fast Bacilli (AFB) and MC&S on three consecutive days.

Arrange an urgent chest x-ray.

Advise patient on infection control measures.

Urgently refer to TB consultants as below – DO NOT wait for results

Contact community TB nursing team for advice and support as required.

Do Not Refer

Patients who are symptomatic for TB infection should be urgently referred to the Infectious Diseases, Respiratory team or Paediatric TB service via ERS and highlighted as urgent – suspected TB.

Do not refer patients who are symptomatic of TB infection to the TB nursing team, however we are happy to be contacted for advice and support.

Do not refer suspected TB cases via the 2 week cancer pathway.

No Management on Guidelines Listed

• Referrals will be accepted for patients who meet that above care pathway criteria.
• We accept all age groups.
• The patient must reside in Hull or the East Riding of Yorkshire catchment area.

Referrals

Completed referral forms to the Community TB Nursing Service will be accepted via:

• SystmOne to SystmOne, or ERS.
• Email to: chcp.tbnursingservice@nhs.net
• Telephone contact: 01482 344221

Mail to: TB Nursing Service, Newington Health Centre, 2 Plane Street, Hull, HU3 6BX       

Information to Include

• Please complete all sections of the referral form.