Current through Register Vol. 49, No. 18, September 16, 2024
PURPOSE: This rule establishes tuberculosis testing
requirements for residents and workers in longterm care facilities and state
correctional centers.
(1)
General Requirements. Long-term care facilities and state correctional centers
shall screen their residents and staff for tuberculosis using the Mantoux
method purified protein derivative (PPD) five tuberculin unit (5 TU) test. Each
facility shall be responsible for ensuring that all test results are completed
and that documentation is maintained for all residents, employees, and
volunteers.
(A) In interpreting this rule,
long-term care facilities shall include employees, volunteers, and residents of
residential care facilities I, residential care facilities II, intermediate
care facilities and skilled nursing facilities as defined in section
198.006,
RSMo.
(B) In interpreting this
rule, state correctional centers shall include all employees and volunteers of
the Missouri Department of Corrections and the residents of all correctional
institutions operated by the Missouri Department of Corrections.
(C) Whenever tuberculosis is suspected or
confirmed, or tuberculosis infection is diagnosed among residents, employees or
volunteers, the Department of Health or local health authority shall be
notified as required in
19
CSR 20-20.020(2).
(2) Long-Term Care Residents.
Within one (1) month prior to or one (1) week after admission, all residents
new to long-term care are required to have the initial test of a Mantoux PPD
two (2)-step tuberculin test. If the initial test is negative, zero to nine
millimeters (0-9 mm), the second test, which can be given after admission,
should be given one to three (1-3) weeks later. Documentation of chest X ray
evidence ruling out tuberculosis disease within one (1) month prior to
admission, along with an evaluation to rule out signs and symptoms compatible
with infectious tuberculosis, may be accepted by the facility on an interim
basis until the Mantoux PPD two (2)-step test is completed.
(A) All skin test results are to be
documented in millimeters (mm) of induration.
(B) Bacillus of Calmette and Guerin (BCG)
vaccination shall not prevent residents from receiving a tuberculin
test.
(C) A reaction of ten
millimeters (10 mm) or more shall be considered as infected with
Mycobacterium tuberculosis for an individual with a history of
BCG vaccination.
(D) Evidence of
tuberculosis infection is considered to be a reaction of five millimeters (5
mm) or more for all contacts to infectious tuberculosis or for an individual
who is immunosuppressed or has abnormal chest X-ray findings consistent with
old healed tuberculosis disease, and ten millimeters (10 mm) or more for all
others.
(E) Residents with a
negative, zero to nine millimeters (0-9 mm), Mantoux PPD two (2)-step test need
not be routinely retested unless exposed to infectious tuberculosis or they
develop signs and symptoms which are compatible with tuberculosis
disease.
(F) Residents with a
documented history of tuberculosis infection or an adequate course of
preventive treatment shall not be required to be retested. Residents with a
documented history of tuberculosis disease and adequate chemotherapy shall not
be required to be retested. In the absence of documentation, a repeat test
shall be required.
(G) All skin
test results of five millimeters (5 mm) or more for contacts to infectious
tuberculosis or for an individual who is immunocompromised, or ten millimeters
(10 mm) or more for all others, shall require a chest X ray within one (1)
week, or a review of the results of a chest X ray taken within the month prior
to admission along with an evaluation to rule out signs and symptoms compatible
with tuberculosis disease to rule out active pulmonary disease.
(H) Individuals with a positive finding
presenting evidence of a recent, within one (1) month of the date of admission,
chest X ray need not be given a new X ray. However, the results of the X ray
must be reviewed in the light of the additional information of the
identification of tuberculosis infection as indicated by the Mantoux PPD skin
test.
(I) An individual who is
skin-test positive with a normal chest X ray should be considered for
preventive medication. Those who complete a recommended course of preventive
treatment and those for whom preventive treatment is not medically indicated
need have no further testing for tuberculosis unless signs and symptoms which
are compatible with tuberculosis disease are present.
(J) All residents of long-term care
facilities who are exposed to a case of infectious tuberculosis or who develop
signs and symptoms which are compatible with tuberculosis disease shall be
medically evaluated. All long-term care facility residents shall have a
documented annual evaluation to rule out signs and symptoms of tuberculosis
disease.
(3) Long-Term
Care Employees and Volunteers. All new long-term care facility employees and
volunteers who work ten (10) or more hours per week are required to obtain a
Mantoux PPD two (2)-step tuberculin test within one (1) month prior to starting
employment in the facility. If the initial test is zero to nine millimeters
(0-9 mm), the second test should be given as soon as possible within three (3)
weeks after employment begins, unless documentation is provided indicating a
Mantoux PPD test in the past and at least one (1) subsequent annual test within
the past two (2) years. It is the responsibility of each facility to maintain a
documentation of each employee's and volunteer's tuberculin status.
(A) All skin test results are to be
documented in millimeters (mm) of induration.
(B) BCG vaccination shall not prevent
employees and volunteers from receiving a tuberculin test.
(C) For an individual with a history of BCG
vaccination, a reaction of ten millimeters (10 mm) or more shall be considered
as infected with Mycobacterium tuberculosis.
(D) Evidence of tuberculosis infection is
considered to be a reaction of five millimeters (5 mm) or more for all contacts
to infectious tuberculosis or for an individual who is immunosuppressed or has
abnormal chest X ray findings consistent with old healed tuberculosis disease,
and ten millimeters (10 mm) or more for all others.
(E) Employees and volunteers with an initial
zero to nine millimeters (0-9 mm) Mantoux PPD two (2)-step test shall be one
(1)-step tuberculin tested annually and the results recorded in a permanent
record.
(F) Employees and
volunteers with a documented history of a positive Mantoux PPD test shall not
be required to be retested. In the absence of documentation, a repeat test
shall be required.
(G) All positive
findings shall require a chest X ray to rule out active pulmonary
disease.
(H) Individuals with a
positive finding need not have repeat annual chest X rays. They shall have a
documented annual evaluation to rule out signs and symptoms of tuberculosis
disease.
(I) An individual who is
skin-test positive with a normal chest X ray should be considered for
preventive medication. Those who complete a recommended course of preventive
medication need have no further testing for tuberculosis unless signs and
symptoms which are compatible with tuberculosis disease are present.
(J) All employees and volunteers of long-term
care facilities who are exposed to a case of infectious tuberculosis or who
develop signs and symptoms which are compatible with tuberculosis disease shall
be medically evaluated. All employees or volunteers of these facilities shall
have a documented annual evaluation to rule out signs and symptoms of
tuberculosis disease.
(4) State Correctional Centers Residents. All
residents of state correctional centers are required to obtain a Mantoux PPD
two (2)-step tuberculin test upon admission to rule out tuberculosis. If the
initial test is negative, zero to nine millimeters (0-9 mm), the second test
should be given within ninety (90) days of entrance into the state correctional
system.
(A) All skin test results are to be
documented in millimeters (mm) of induration.
(B) BCG vaccination shall not prevent
residents from receiving a tuberculin test.
(C) For an individual with a history of BCG
vaccination, a reaction of ten millimeters (10 mm) or more shall be considered
as infected with Mycobacterium tuberculosis.
(D) A positive test is defined as having a
reaction of five millimeters (5 mm) or more for all contacts to infectious
tuberculosis or for an individual who is immunosuppressed or has abnormal chest
X ray findings consistent with old healed tuberculosis disease, and ten
millimeters (10 mm) or more for all others.
(E) Individuals with an initial negative zero
to nine millimeters (0-9 mm) Mantoux PPD two (2)-step test shall be one
(1)-step tuberculin tested annually and the results recorded in a permanent
record.
(F) Individuals with a
documented history of a positive Mantoux PPD test shall not be required to be
retested. In the absence of documentation, a repeat test shall be
required.
(G) All positive findings
shall require a chest X ray to rule out active pulmonary disease.
(H) Individuals with a positive finding need
not have repeat annual chest X rays. They shall have a documented annual
evaluation to rule out signs and symptoms of tuberculosis disease.
(I) An individual who is skin-test positive
with a normal chest X ray should be considered for preventive medication. Those
who complete a recommended course of preventive medication need have no further
testing for tuberculosis unless signs and symptoms which are compatible with
tuberculosis disease are present.
(J) All residents of state correctional
centers who are exposed to a case of infectious tuberculosis or who develop
signs and symptoms which are compatible with tuberculosis disease shall be
medically evaluated. All residents shall have a documented annual evaluation to
rule out signs and symptoms of tuberculosis disease.
(5) Missouri Department of Corrections New
Employees and Volunteers. All new employees and volunteers who work ten (10) or
more hours per week for the Missouri Department of Corrections are required to
obtain a Mantoux PPD two (2)-step tuberculin test within three (3) weeks of
starting employment. If the initial test is negative, zero to nine millimeters
(0-9 mm), the second test should be given one to three (1-3) weeks after the
initial test. It is the responsibility of each state correctional center to
maintain documentation of each employee's or volunteer's tuberculin status.
(A) All skin test results are to be
documented in millimeters (mm) of induration.
(B) BCG vaccination shall not prevent new
employees and volunteers from receiving a tuberculin test.
(C) For an individual with a history of BCG
vaccination, a significant reaction of ten millimeters (10 mm) or more shall be
considered as infected with Mycobacterium
tuberculosis.
(D) A
positive test is defined as having a reaction of five millimeters (5 mm) or
more for all contacts to infectious tuberculosis or for an individual who is
immunosuppressed or has abnormal chest X ray findings consistent with old
healed tuberculosis disease, and ten millimeters ( 10 mm) or more for all
others.
(E) Employees and
volunteers with a negative zero to nine millimeters (0-9 mm) Mantoux PPD two
(2)-step test shall be one (1)-step tuberculin tested annually and the results
recorded in a permanent record.
(F)
Employees and volunteers with a documented history of a positive Mantoux PPD
test shall not be required to be retested. In the absence of documentation, a
repeat test shall be required.
(G)
All positive findings shall require a chest X ray to rule out active pulmonary
disease.
(H) Individuals with a
positive finding need not have repeat annual chest X rays. They shall have a
documented annual evaluation to rule out signs and symptoms of tuberculosis
disease.
(I) An individual who is
skin-test positive with a normal chest X ray should be considered for
preventive medication. Those who complete a recommended course of preventive
medication need have no further testing for tuberculosis unless signs and
symptoms which are compatible with tuberculosis disease are present.
(J) All employees and volunteers of state
correctional centers who are exposed to a case of infectious tuberculosis or
who develop signs and symptoms which are compatible with tuberculosis disease
shall be medically evaluated. All employees and volunteers shall have a
documented annual evaluation to rule out signs and symptoms of tuberculosis
disease.
*Original authority: 199.350, RSMo
1992.
