Containing a Deadly Disease from the Community

Published: April 11, 2018
Comolita Fagan, RN, nurse manager of the TB unit View Larger Image
The TB unit team shares a laugh. View Larger Image

UF Health Jacksonville is home to one of Florida’s two tuberculosis treatment units.

It is one of the world’s deadliest diseases, killing 1.7 million people in 2016, according to the Centers for Disease Control and Prevention. It only takes a cough or sneeze for tuberculosis to spread. Once you breathe in the bacteria, TB can settle in your lungs and eventually spread to your kidneys, spine and brain.

In July 2012, the Florida surgeon general permanently closed the only tuberculosis treatment facility in in the state. The Florida Department of Health turned to UF Health Jacksonville and Jackson Memorial Hospital in Miami to provide specialized care for patients with TB.

The Florida Department of Health must be notified of anyone diagnosed with TB, to prevent an epidemic. If patients comply with treatment, they can often complete their regimen at home. Noncompliant patients — those who refuse treatment or miss checkups — are court-ordered to receive care at one of the two designated hospitals in the state.

The focus of UF Health Jacksonville’s TB isolation unit is to protect the public from tuberculosis and to provide comprehensive treatment for adult and pediatric patients. The unit becomes the patient’s home, with the average stay lasting six months. They can have visitors, but cannot freely come and go until they are no longer contagious.

Comolita Fagan, RN, serves as the nurse manager of the unit and is part of the multidisciplinary care team of UF Health pharmacists, hospitalists, case managers and respiratory therapists as well as physicians from the Florida Department of Health. They meet weekly online to discuss each patient’s care plan, including medication and behavioral therapy. They invite the families of patients to join and ask questions.

“The treatment is truly multidisciplinary and includes family collaboration,” Fagan said. “Having the patient and family involved every week makes the process much more successful.”

In order for the unit to uphold national standards, specialized training is key. All nursing staff go through 16 hours of training on TB regulations set by the CDC, and must pass a competency exam. They are also required to complete eight hours of training annually.

UF Health Jacksonville was selected as one of the two approved facilities, partially for its location — one hospital for patients in North Florida and one for those in South Florida — but largely because of its staff’s experience in treating the homeless population. According to the CDC, this group has a high occurrence of conditions that increase the risk of TB, such as HIV, substance abuse and living in close quarters, like shelters.

“We have incorporated an Alcoholics Anonymous program into the resources for these patients, so they have the opportunity to attend once they are no longer TB-positive,” Fagan said. “Many of them have addictions, so they can get help before they leave.”

UF Health Jacksonville also partners with the Sulzbacher Center and the health department to provide patients who are homeless with resources for housing, insurance and education. They are not discharged without being set up for success and a hopeful future.

The mental health needs of patients with TB have also become more apparent over time. “We realized after starting the program that the mental health component was a major part,” Fagan said. “These patients are here for months and they need someone to talk to. We now complete annual training for competencies addressing the psychosocial aspect of their care.”

UF Health Jacksonville’s ability to manage high-risk TB cases benefits the patients they serve and ensures the safety of residents throughout Florida.

“We’re known across the state for collaborating within the community in order to make it better,” Fagan said. “We know we’re making an impact by preventing TB from spreading through the community. We live our mission.”

Comolita Fagan, RN, nurse manager of the TB unit
The TB unit team shares a laugh.

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UF Health Media Relations