Section 696.100  Definition of Terms

 

For the purpose of this Part, the following shall be the accepted definitions of the terms used herein:

 

            "Anergy" means the absence of a reaction to skin test antigens, such as tuberculin (when the person is infected with the organism tested) because of immunosuppression.  The absence of a reaction to the tuberculin skin test does not rule out the diagnosis of tuberculosis (TB) infection or disease.  Anergy may be caused by many factors, such as HIV infection, overwhelming miliary or pulmonary TB, severe or febrile illness, measles or other viral infections, Hodgkin's disease, sarcoidosis, live virus vaccination, and the administration of corticosteroids or immunosuppressive drugs.

 

            "Bacteriologic Examinations" means tests done in a mycobacteriology laboratory to diagnose TB disease, including smears for acid-fast bacilli (AFB), cultures and other tests for Mycobacterium (M.) tuberculosis, and drug susceptibility tests.

 

            "BCG Vaccine" means a TB vaccine used in many parts of the world.

 

            "Checklist of Signs and Symptoms of TB Disease" means a list that includes the following signs and symptoms:  pulmonary – productive prolonged cough, chest pain, hemoptysis; generalized – fever, chills, night sweats, easy fatigability, loss of appetite and weight loss.

 

            "Close Contacts" means those sharing the same household or other enclosed environments of persons known or suspected to have TB.

 

            "Confirmed Case" means an occurrence of TB disease that is laboratory confirmed or, in the absence of laboratory confirmation, an occurrence that meets the clinical case definition.

 

            Laboratory confirmation – Laboratory criteria for diagnosis includes isolation of M. tuberculosis from a clinical specimen; demonstration of M. tuberculosis from a clinical specimen by DNA probe or mycolic acid pattern on high-pressure liquid chromatography; or demonstration of acid-fast bacilli in a clinical specimen when a culture has not been or cannot be obtained.

 

            Clinical case definition – A clinical case meets all the following criteria:  a positive TB screening test; other signs and symptoms compatible with TB, such as an abnormal, unstable (worsening or improving) chest radiograph, or clinical evidence of current disease; treatment with two or more anti-tuberculosis medications; and completed diagnostic evaluation.

 

            "Department" means the Illinois Department of Public Health.

 

            "Diagnostic Evaluation" means a process used to diagnose TB disease, which includes a physical examination, medical history, TB screening test, chest radiograph and bacteriologic examinations.

 

            "Directly Observed Therapy" or "DOT" means a process by which a trained healthcare worker or other designated trained person watches the patient swallow each dose of TB medication.  Family members are generally not recommended to provide DOT.

 

            "Directly Observed Preventive Therapy" or "DOPT" means a process by which a trained healthcare worker or other designated trained person watches the patient swallow each dose of preventive TB medication.  Family members are generally not recommended to provide DOPT.

 

            "Employee" means a full-time, part-time or temporary worker who receives compensation.  (See definition of "Volunteer".)

 

            "Facility" means any organization or unit of an organization.

 

            "Healthcare Facility" means a hospital, medical ward in a correctional facility, nursing home or hospice. (See definition of "Other Healthcare Setting".)

 

            "Healthcare Worker" means an employee or volunteer in a healthcare facility who has the potential for exposure to M. tuberculosis.  Healthcare workers may include, but are not limited to, physicians, nurses, aides, dental workers, technicians, workers in laboratories and morgues, emergency medical service personnel, part-time personnel, temporary staff (such as students) not employed by the healthcare facility, and persons who are not involved directly in patient care but who are potentially at risk for occupational exposure to M. tuberculosis (e.g., volunteers, or dietary, housekeeping, maintenance, clerical, and janitorial staff).

 

            "High-Risk Congregate Setting" means, but is not limited to, detention centers, in-patient healthcare facilities, nursing homes and other long-term care facilities for the elderly, mental health facilities, licensed supportive residences for HIV-infected persons, shelters for the homeless, other long-term residential facilities and programs that treat persons who inject non-prescribed drugs or other substance users in locally identified high-risk groups (e.g., crack cocaine users).  Other long-term care facilities include facilities that care for the developmentally disabled, are designed for retirees, or others, and that are considered high-risk congregate settings according to a risk assessment performed in cooperation with the local TB control authority.

 

            "High-Risk for Nonadherence to a Prescribed Treatment Regimen" means any person who has a history of treatment nonadherence; whose treatment has failed or disease has relapsed; who uses alcohol or controlled substances; who has mental, emotional, or physical impairments that interfere with the ability to self-administer medications; or who is a child or adolescent.

 

            "High-Risk Groups" means the following categories of people who should be screened for TB infection because of an increased probability of becoming infected with TB, and/or who, once infected, have increased probability of progressing to TB disease:

 

            close contacts;

 

            persons who inject non-prescribed drugs or other substance users in locally identified high-risk groups (e.g., crack cocaine users);

 

            persons who have medical risk factors known to increase the risk for disease if infection occurs.  Medical risk factors means the following conditions:  infection with HIV/AIDS; diabetes mellitus; conditions requiring prolonged high-dose corticosteroid therapy and other immunosuppressive therapy (including bone marrow and organ transplantation); chronic renal failure; some hematologic disorders (e.g., leukemias and lymphomas); other specific malignancies (carcinoma of the head or neck); body weight of 10% or more below ideal body weight; silicosis; gastrectomy; jejunoileal bypass; abnormal chest radiographs showing fibrotic lesions consistent with healed TB; and abnormal chest radiographs showing parenchymal lung scarring in persons with a positive TB screening test who have not previously received TB treatment or preventive therapy;

 

            clients, employees and volunteers of high-risk congregate settings;

 

            healthcare workers who serve clients in high-risk groups;

 

            foreign-born persons, including children, who have arrived within the past five years from countries that have a high TB incidence or prevalence;

 

            groups defined locally as high risk (e.g., some medically underserved low-income populations and some racial or ethnic minority populations);

 

            Infants, children and adolescents exposed to adults in high-risk categories.

 

            "Infection" means the condition in which organisms (e.g., M. tuberculosis) capable of causing disease enter the body and elicit a response from the host's immune defenses.  TB infection may or may not progress to clinical disease.

 

            "Infectious" means a person who has, or is suspected of having, pulmonary or laryngeal TB and who:

 

            coughs, is undergoing cough-inducing or aerosol-generating procedures, or has sputum smears that contain acid-fast bacilli (AFB); and

 

            is not receiving treatment, has just begun treatment, or has a poor clinical or bacteriologic response to treatment.  A person on treatment for one month or less is considered to have just begun treatment.  A poor clinical response to treatment can be suggested by a failure of signs and symptoms to improve after two months of treatment.  A poor bacteriologic response to treatment can be suggested by a failure of AFB on smear to decrease after two weeks of treatment.

 

            "Intermittent Therapy" means therapy administered either two or three times per week, rather than each day.

 

            "Isolation" means the separation of a person with suspected or confirmed tuberculosis disease from other persons using universally-accepted techniques that effectively prevent transmission of M. tuberculosis during that person's period of communicability.

 

            "Isolation Rooms" means rooms with special characteristics, including negative-pressure ventilation, to prevent the spread of droplet nuclei expelled by a TB patient.

 

            "Likely to Become Infectious" means a person whose treatment has failed; whose disease has relapsed; who does not consistently adhere to or complete a prescribed treatment regimen; who has received inadequate treatment; or who has drug-resistant disease.

 

            "Local TB Control Authority" means the agency at the local level recognized by the Department as having jurisdiction over the prevention and control of tuberculosis.  The local TB control authority may be an autonomous TB board or a TB program within a local health department.

 

            "Long-Term Inmate" means an inmate who will remain in custody for a period of 14 days or longer.

 

            "Mantoux Tuberculin Skin Test or Mantoux Skin Test" means a method of skin testing that is performed by injecting 0.1 mL of purified protein derivative (PPD) tuberculin containing five tuberculin units into the dermis of the forearm with a needle and syringe.

 

            "Negative Cultures" means cultures that contain no detectable tubercle bacilli.

 

            "Nonadherence" means not following the recommended course of treatment or therapy by not taking all the medications in the manner prescribed for the entire length of time.

 

            "Not Infectious" means a person previously determined to be infectious who now meets the following criteria:

 

            received a treatment regimen for two or more weeks composed of multiple drugs to which the organisms are susceptible  in accordance with the incorporated publication, Treatment of TB and TB Infection;

 

            has favorable clinical response to treatment; and

 

            has three consecutive negative sputum smear results from sputum collected on different days.

 

            "OSHA" means the U.S. Department of Labor, Occupational Safety and Health Administration.

 

            "Other Healthcare Setting" means an ambulatory care facility, emergency department, home healthcare setting, emergency medical services, medical and dental office or any location where medical care is provided. (See definition of "Healthcare Facility".)

 

            "Past or Present Behavior that Indicates a Substantial Likelihood of Not Cooperating with Prevention and Control Measures" means, but is not limited to:

 

            refusal or failure to keep appointments for diagnosis or treatment;

 

            refusal or failure to consistently adhere to and complete a prescribed preventive therapy or disease treatment regimen;

 

            refusal or failure to participate in DOPT or DOT;

 

            disregard for isolation procedures;

 

            leaving the hospital against medical advice; or

 

            inability or unwillingness to voluntarily use prevention and control measures.

 

            "Preventive Therapy" means treatment of TB infection to prevent the progression to clinically active disease.

 

            "Relapse" means the return of TB disease after a partial recovery from disease.

 

            "Short-Term Inmate" means an inmate who remains in custody for less than 14 days, especially pretrial detainees likely to be released without supervision or placed in the community under court supervision.

 

            "Suspected Case" means an occurrence that is being considered as TB disease while diagnostic procedures are being completed, whether or not treatment has been started.

 

"TB Screening Test" means a federal Food and Drug Administration (FDA) approved screening test to detect latent TB Infection.  Examples of screening tests include, but are not limited to, the Mantoux tuberculin skin test and whole blood interferon-gamma release assays.

 

            "Treatment Failure" means TB disease in patients who do not respond to chemotherapy and whose disease worsens after having improved initially.

 

            "Volunteer" means a person who, for a period of time, provides services of his or her own free will with no promise of compensation. (See definition of "employee".)

 

(Source:  Amended at 32 Ill. Reg. 4010, effective February 29, 2008)