Current through Register Vol. 48, No. 9, September 27, 2024
A. All facilities shall conduct an annual
tuberculosis risk assessment (see Section 101.SS) in accordance with CDC
guidelines to determine the appropriateness and frequency of tuberculosis
screening and other tuberculosis related measures to be taken.
B. The risk classification, for example, low
risk, medium risk, shall be used as part of the risk assessment to determine
the need for an ongoing TB screening program for staff and volunteers and
patients and the frequency of screening. A risk classification shall be
determined for the entire facility. In certain settings, for example,
healthcare organizations that encompass multiple sites or types of services,
specific areas defined by geography, functional units, patient population, job
type, or location within the setting may have separate risk classifications.
C. Staff and Volunteers
Tuberculosis Screening.
1. Tuberculosis
Status. Prior to date of hire or initial patient contact, the tuberculosis
status of staff and volunteers shall be determined in the following manner in
accordance with the applicable risk classification:
2. Low Risk:
a. Baseline two-step Tuberculin Skin Test
("TST") or a single Blood Assay for Mycobacterium tuberculosis
("BAMT"): All staff and volunteers (within three (3) months prior to
contact with patients) unless there is a documented TST or a BAMT result during
the previous twelve (12) months. If a newly employed staff or volunteer has had
a documented negative TST or a BAMT result within the previous twelve (12)
months, a single TST (or the single BAMT) can be administered and read to serve
as the baseline prior to patient contact.
b. Periodic TST or BAMT is not
required.
c. Post-exposure TST or a
BAMT for staff and volunteers upon unprotected exposure to M.
tuberculosis: Perform a contact investigation when unprotected
exposure is identified. Administer one (1) TST or a BAMT as soon as possible to
all staff who have had unprotected exposure to an infectious TB case or
suspect. If the TST or the BAMT result is negative, administer another TST or a
BAMT eight to ten (8 to 10) weeks after that exposure to M.
tuberculosis ended.
d.
Baseline positive with or without documentation of treatment for latent TB
infection ("LTBI") (see Section 101.Z) or TB disease shall have a symptoms
screen prior to employment and annually thereafter.
e. Upon hire, staff and volunteers with a
newly positive test result for M. tuberculosis infection (for
example, TST or BAMT) or signs or symptoms of tuberculosis, for example, cough,
weight loss, night sweats, fever, shall have a chest radiograph performed
immediately to exclude TB disease (or evaluate an interpretable copy taken
within the previous three (3) months). Repeat radiographs are not needed unless
symptoms or signs of TB disease develop or unless recommended by a physician.
These staff members and volunteers will be evaluated for the need for treatment
of TB disease or LTBI and will be encouraged to follow the recommendations made
by a physician with TB expertise (for example, the Department's TB Control
program).
3. Medium
Risk:
a. Baseline two-step TST or a single
BAMT: All staff and volunteers (within three (3) months prior to contact with
patients) unless there is a documented TST or a BAMT result during the previous
twelve (12) months. If a newly employed staff member or volunteer has had a
documented negative TST or a BAMT result within the previous twelve (12)
months, a single TST (or the single BAMT) can be administered to serve as the
baseline prior to patient contact.
b. Periodic testing (with TST or BAMT):
Annually, of all staff and volunteers who have risk of TB exposure and who have
previous documented negative results. Instead of participating in periodic
testing, staff and volunteers with documented TB infection (positive TST or
BAMT) shall receive a symptom screen annually. This screen shall be
accomplished by educating the staff or volunteer who have documented TB
infection about symptoms of TB disease (including the staff's and/or
volunteers' responses concerning symptoms of TB disease), documenting the
questioning of the staff or volunteers about the presence of symptoms of TB
disease, and instructing the staff or volunteers to report any such symptoms
immediately to the administrator. Treatment for LTBI shall be considered in
accordance with CDC and Department guidelines and, if recommended, treatment
completion shall be encouraged.
c.
Post-exposure TST or a BAMT for staff or volunteers upon unprotected exposure
to M. tuberculosis: Perform a contact investigation (see
Section 101.I) when unprotected exposure is identified. Administer one (1) TST
or a BAMT as soon as possible to all staff and volunteers who have had
unprotected exposure to an infectious TB case or suspect. If the TST or the
BAMT result is negative, administer another TST or BAMT eight to ten (8 to 10)
weeks after that exposure to M. tuberculosis ended.
4. Baseline Positive or Newly
Positive Test Result:
a. Baseline positive
with or without documentation of treatment for LTBI or TB disease shall have a
symptoms screen prior to employment and annually thereafter.
b. Upon hire, staff and volunteers with a
newly positive test result for M.tuberculosis infection (for
example, TST or BAMT) or signs or symptoms of tuberculosis,
for example, cough, weight loss, night sweats, fever, shall
have a chest radiograph performed immediately to exclude TB disease (or
evaluate an interpretable copy taken within the previous three (3) months).
Repeat chest radiographs are not required unless symptoms or signs of TB
disease develop or unless recommended by a physician. These staff members and
volunteers will be evaluated for the need for treatment of TB disease or LTBI
and will be encouraged to follow the recommendations made by a physician with
TB expertise (for example, the Department's TB Control
program).
c. Staff and volunteers
who are known or suspected to have TB disease shall be excluded from work,
required to undergo evaluation by a physician, and permitted to return to work
only with written approval by the Department's TB Control program. Repeat chest
radiographs are not required unless symptoms or signs of TB disease develop or
unless recommended by a physician.
D. Patients who are known or suspected to
have TB disease shall be transferred from the facility if the facility does not
have an Airborne Infection Isolation room, required to undergo evaluation by a
physician, and permitted to return to the facility only with written approval
by the Department's TB Control program.
E. Individuals who have been declared in
writing to be in an emergency crisis stabilization status may be admitted to
the facility without the initial step of the two-step tuberculin skin test
and/or while awaiting the result of a BAMT. If an individual has any symptoms
of active tuberculosis, he or she shall be placed in an area separate from the
general population. This admission to the facility may be made provided that:
1. There is documentation at the facility of
the declaration by the SCDMH that the admission is, in fact, an emergency
(NOTE: Only this agency may declare these crisis stabilization admissions to be
an emergency); and
2. The patient
will receive the initial step of the two-step tuberculin test within
seventy-two (72) hours of admission to the facility. The second step of the
two-step tuberculin skin test must be administered within the next seven to
fourteen (7 to 14) days; or
3.
There is written evidence of a chest x-ray within one (1) month prior to
admission and a written assessment by a physician or other authorized
healthcare provider that there is no active TB present and a negative
assessment for signs and/or symptoms of tuberculosis.
