While reports of an "outbreak of tuberculosis" at Salt Lake homeless shelters have been grossly exaggerated, a handful of cases in recent years has opened communication between shelter and community health staff on how to deal with the disease.
The shelter is not equipped to provide quarantine for the illness, which can be spread through the air and casual contact. Salt Lake Shelter and Community Resource Center director Patrick Poulin is worried that patients with TB may be prematurely returned to the shelter - something health officials say has not happened.In the past few years, seven active cases of the illness have been identified among the homeless population, according to LaDene Larsen of the Department of Health's Chronic Disease Bureau.
"It's not a high number. You can count the cases on your fingers in recent years," she said.
The issue came to a head when a homeless individual who was being treated for tuberculosis was returned to the shelter. Shelter staff members were given the impression that the individual was infectious because a doctor suggested he wear a mask. He wasn't infectious, according to Dr. Barbara McKusker, a tuberculosis consultant, who reviewed the case. "It was perfectly appropriate to return him to the shelter," she said.
During recent screenings at area shelters, a number of people tested positive on skin tests, but Larsen said that only indicates that they have at sometime been exposed to the illness - possibly in the distant past. Of those who are exposed, very few become infected. And only 5 percent of those infected develop the disease in the course of their lifetime.
"None of the people who had positive skin tests have any symptoms," she said.
There were enough differences, Larsen said, to indicate that no one was exposed at the shelters or even had the same source of exposure.
About 20 people gathered Wednesday at the shelter to discuss protocol to deal with tuberculosis. A committee was formed to draft a formal document that will outline the responsibility of the state and local health departments, as well as shelter staff and the Wasatch Homeless Healthcare Program.
"My policy is that no one suspected of having tuberculosis be housed in the shelter," said Dr. Sylvia Corral, director of the Wasatch Homeless Healthcare Program, which operates the shelter's clinic.
Instead, Salt Lake City-County Health officials, shelter staff and others are trying to establish a housing unit for people who are undergoing treatment for the illness. So far, they've had little luck. Funding will be a big issue, according to Dr. Harry Gibbons, director of the Salt Lake City-County Health Department.
In addition to specific guidelines on who will treat homeless individuals who are suspected of having the illness, Mike Hoglund, Holy Cross Hospital, has asked for "clear hospital discharge criteria," as well. The hospital receives most of the valley's indigent patients and "as someone trying to discharge within the system, it's not clear where they should go," he said.
The often-heated discussion is about the 10th to be held on the issue, according to Pamela Atkinson, Intermountain Health Care and chairwoman of a homeless health-care committee, who presided over the gathering.