Management in Custody

Staff with disease should stay off work until the treatment course is complete and serial sputum samples no longer contain bacilli. Staff in contact with disease who have been vaccinated with BCG are at low risk of acquiring disease but should minimize their time spent in the cell. Those who have not received BCG or who are immunocompromised should avoid contact with the detainee wherever possible. Detainees with MAI do not pose a risk to a staff member, unless the latter is immunocompromised. Any staff member who is pregnant, regardless of BCG status or type of TB, should avoid contact.

Anyone performing mouth-to-mouth resuscitation with a person with untreated or suspected pulmonary TB should be regarded as a household contact and should report to occupational health or their physician if no other route exists. They should also be educated regarding the symptoms of TB. Anyone who is likely to come into repeated contact with individuals at risk of

TB should receive BCG (if he or she has not already done so), regardless of age, even though there is evidence to suggest that BCG administered in adult life is less effective. This does not apply to individuals who are immunocompromised or pregnant women. In the latter case, vaccination should preferably be deferred until after delivery.

Detainees with disease (whether suspected or diagnosed) who have not been treated or treatment is incomplete should be kept in custody for the minimum time possible. Individuals with TB who are immunocompromised are usually too ill to be detained; if they are, they should be considered at greater risk of transmitting disease to staff. Any detainee with disease should be encouraged to cover his or her mouth and nose when coughing and sneezing.

Staff should wear gloves when in contact with the detainee and when handling clothing and bedding. Any bedding should be bagged after use and laundered or incinerated. The cell should be deemed out of action until it has been ventilated and professionally decontaminated, although there is no hard evidence to support that there is a risk of transmission from this route (70).

7.4. Severe Acute Respiratory Syndrome

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