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Identify a single senior individual from the site who will act as a liaison and be responsible for organizational aspects of the contact investigation on site, usually a school principal, workplace manager or occupational health manager, etc.
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Some exposures may involve multiple sites (eg, an individual transferred between hospitals or correctional facilities); initial planning should involve key individuals across all affected sites to ensure a consistent approach to risk-assessment and contact follow-up.
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Protect the confidentiality of the index case (investigations should be carried out in compliance with the relevant legal/legislative requirements; provincial/territorial legislation may permit or require disclosure in specific circumstances). This may not be easy; there may be considerable pressure to disclose details and, in many situations, others may be able to guess the identity of the case. Particularly if the identity of the case is widely known or suspected, enlist the help of setting personnel (eg, the principal or manager) to plan for successful reintegration of the TB case once noninfectious.
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Visit the site beforehand to get a sense of the environment and organize the screening arrangements; get input from the setting’s liaison person to ensure that screening is carried out at a time and in a way that offers the best opportunity for contacts to come to the screening.
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Ensure that adequate TB staffing will be available for the screening.
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Include key players at the site, such as occupational health services, human resources or other administrative staff, as well as union health and safety representatives, in planning and communication; they may benefit from information about TB ahead of a general information session, as others will likely look to them for advice.
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Prepare a communication plan; identify one individual who will be responsible for media and communications to the general public if necessary; alert public health communications staff.
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Provide written information about TB and the contact follow-up plan, and offer general information/education sessions, for all parents/employees/residents prior to the screening sessions; if the number of contacts is relatively small, a separate session specifically for them may be helpful.
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Identify the referral plan for contacts who are TST-positive or symptomatic; manage all contacts referred for medical evaluation consistently, ideally by a limited number of health care providers working in coordination with public health. It can be confusing and alarming for a group of contacts if the work-up and treatment advice are inconsistent from person to person.
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Ensure the results of the medical evaluation are provided promptly to the appropriate public health authority. The public health TB program should review the outcomes of the investigation promptly to determine if there is evidence of transmission and, if so, assess if there is an identifiable next-closest group of contacts to whom the investigation can feasibly be expanded.
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