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.

 

 

 

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@salemhealth.org

503-814-7250

Fax: 503-814-7253

 

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