[MCOH-EH] Question on Targeted Annual TB screenings in low risk hospital employees???

PRATER, DEANNA deanna.prater at bayareahospital.org
Wed Nov 14 10:07:15 PST 2018

We do a TSPOT upon hire.  No more two step testing.

From: MCOH-EH <mcoh-eh-bounces at mylist.net> On Behalf Of Shadowens, Lisa M
Sent: Wednesday, November 14, 2018 09:45
To: mcoh-eh at mylist.net
Cc: Morehart, Tamara <TAMARA_MOREHART at bshsi.org>; Diaz, Denise <Denise_Diaz at bshsi.org>
Subject: [MCOH-EH] Question on Targeted Annual TB screenings in low risk hospital employees???

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Thank you in advance!! I would like to know your responses to my question on:

How do other hospitals do their ANNUAL LOW RISK Healthcare Workers TB screenings?  Is anyone using the CDC and DHEC recommended practice of TARGETED TESTING, only doing annual respiratory TB sign/symptoms questionnaire? I went to a recent TB DHEC 3 day conference and ALL the TALK WAS MOVING TO TARGETED TB TESTING BASED ON RISK LEVELS. Bon Secours St Francis is now/currently doing TSPOT TB IGRA test on our new hire on-boarding, and have stopped all two (2) step TST. We are moving forward with policy changes and I need input on annual practices and TB exposure for employees. I understand the Employee Health Reg. #601 to offer best practice CDC guidance and use Appendix B for calculating your risk. Attached doc to read.

 Regulation 61-16

Minimum Standards for Licensing Hospitals and Institutional General Infirmaries

My state, city, and hospital is and has been in the LOW RISK category for MTB for over 10 years. The CDC Targeted testing information sheet for HCWs is as follows:

[Testing Health Care Workers]
Tuberculosis (TB) transmission has been documented in health care settings where workers and patients come in contact with people who have TB disease.  Periodic testing of health care workers is recommended as part of a TB Infection Control Plan and may be required by state regulations.
TB testing programs should include anyone working or volunteering in health-care settings.  Persons (health care workers and non- health care workers) who have face to face contact or potential exposure to TB through shared air or space with infectious patient(s) should be part of a TB testing program.
There are two types of testing for TB in health care workers.
*         Initial baseline testing upon hire: Two-step testing with a TB skin test or a TB blood test
*         Annual or serial screening: determined by state regulations or risk assessment outcomes.
*         Frequency of TB Testing<https://www.cdc.gov/tb/topic/testing/healthcareworkers.htm#tabs-2-1>
*         TB Skin Test: Two-Step Testing<https://www.cdc.gov/tb/topic/testing/healthcareworkers.htm#tabs-2-2>
*         TB Blood Test<https://www.cdc.gov/tb/topic/testing/healthcareworkers.htm#tabs-2-3>
Frequency of TB Testing
Health care facilities have different TB testing requirements.  Facilities should conduct staff TB testing based on risk classification.
Risk classification

Frequency of testing


Baseline; then test if TB exposure occurs


Baseline, then annually

Potential ongoing transmission

Baseline, then every 8-10 weeks until evidence of transmission has ceased

To determine the risk classification for your facility, review the infection control guidelines and complete the Appendix B. Tuberculosis (TB) Risk Assessment Worksheet(https://www.cdc.gov/tb/publications/guidelines/pdf/appendixb_092706.pdf)<https://www.cdc.gov/tb/publications/guidelines/pdf/appendixb_092706.pdf> (PDF - 195k).
Contact your State TB Control Program(https://www.cdc.gov/tb/links/tboffices.htm)<https://www.cdc.gov/tb/links/tboffices.htm> for information about health care worker TB testing requirements in your state.
Baseline Testing
A baseline test should be given prior to employment.  The result of this test can be compared with later tests (due to potential exposure or as part of annual testing) to help determine if recent TB transmission has occurred in the facility.
Annual or Serial Testing
You may need to test for TB on a regular basis.  To standardize the interpretation of results, the same test should be used for the baseline and the later tests.

Please share your policies and ideas with me as this is an Infection Prevention and Employee Health policy change that is meeting a bit of resistance..... I appreciate all your professional help!!!


Lisa M. Shadowens, RN, CNOR.
St. Francis WorkWell Occupational Health
Employee Health Coordinator
135 Commonwealth Dr., Ste 120
Greenville, SC. 29615
Office 864.675.4681
Fax 864.675.4682
~Be the change you want to see~

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