[MCOH-EH] Revisiting Policies regarding Immune-Suppressed Employees and Duty Exemptions

[Belew, Eva]

Below are the  CDC recommendations on the topic (found in MMWR Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005) which may be useful to you:

HCWs with Medical Conditions Associated with
Increased Risk for Progression to TB Disease
In settings in which HCWs are severely immunocompromised,
additional precautions must be taken. HIV
infection is the highest risk factor for progression from LTBI
to TB disease (22,39,42,49). Other immunocompromising
conditions, including diabetes mellitus, certain cancers, and
certain drug treatments, also increase the risk for rapid progression
from LTBI to TB disease. TB disease can also
adversely affect the clinical course of HIV infection and acquired
immunodeficiency syndrome (AIDS) and can complicate
HIV treatment (31,39,53).
Serial TB screening beyond that indicated by the risk classification
for the setting is not indicated for persons with the
majority of medical conditions that suppress the immune system
or otherwise increase the risk for infection with M. tuberculosis
progressing to TB disease (58). However, consideration
should be given to repeating the TST for HIV-infected persons
whose initial TST result was negative and whose immune
function has improved in response to highly active
antiretroviral therapy (HAART) (i.e., those whose CD4-T
lymphocyte count has increased to >200 cells/mL).
All HCWs should, however, be encouraged during their initial
TB training to determine if they have such a medical condition
and should be aware that receiving medical treatment can
improve cell-mediated immunity. HCWs should be informed
concerning the availability of counseling, testing, and referral
for HIV (50,51). In addition, HCWs should know whether
they are immunocompromised, and they should be aware of
the risks from exposure to M. tuberculosis (1). In certain cases,
reassignment to areas in which exposure is minimized or nonexistent
might be medically advisable or desirable.
Immunocompromised HCWs should have the option of
an assignment in an area or activity where the risk for exposure
to M. tuberculosis is low. This choice is a personal decision
for the immunocompromised HCW (241) (http://
www.eeoc.gov/laws/ada.html). Health-care settings should
provide education and follow infection-control recommendations
(70).
32 MMWR December 30, 2005
Information provided by HCWs regarding their immune
status and request for voluntary work assignments should be
treated confidentially, according to written procedures on the
confidential handling of such information. All HCWs should
be made aware of these procedures at the time of employment
and during initial TB training and education.


From: MCOH-EH [mailto:mcoh-eh-bounces+ebelew=mdmercy.com at mylist.net] On Behalf Of Jordana L. Mcdonald
Sent: Tuesday, March 06, 2018 12:14 PM
To: mcoh-eh at mylist.net
Subject: [MCOH-EH] Revisiting Policies regarding Immune-Suppressed Employees and Duty Exemptions

Hello Everyone:

This was a topic a couple of weeks ago and did not get much response.  I wish to revisit it because I now have an employee with RA on Xeljanz requesting that she be exempted from N95 mask fit testing because she does not believe that she should be caring for patients with TB.  My facility does not appear to have any policies around this and in checking it with Infection Prevention they are concerned that creating such exemptions would create further issues with staffing isolation rooms.  Additionally, we have no idea how many other employees are on similar medications or chemotherapy, though with the aging workforce, I would guess we would expect the incidence of such cases to increase over time.  Should they be exempted only from TB, should they be exempted from all isolation cases?  Does this become another issue like claustrophobia which requires that the various units determine if ability to care for isolation patients is a core job function (so far we are working on the ability to wear an N95 or CAPR related to the claustrophobia).

I would appreciate any input.

Thank you all for this lively group.  Jordana

Jordana McDonald FNP-c
Salem Health Employee Health/Occupational Medicine
Salem Health Medical Group

SALEM HEALTH
Hospitals & Clinics
1002 Bellevue Street SE
Salem, OR 97301
Jordana.mcdonald at salemhealth.org<mailto:Jordana.mcdonald at salemhealth.org>
503-814-7250
Fax: 503-814-7253

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