Tuberculosis (TB) Screening of Patients in Residential Hospice
All patients in a residential hospice must be screened for symptoms of active pulmonary TB disease upon admission or within seven days prior to admission. Screening for latent TB infection using a TB skin test (TST) or TB blood test is not necessary.
Written documentation (including the dates and results) of all pertinent TB screening and evaluations should be easily accessible in the patient's medical record.
Patients with negative baseline TB screening do not need periodic follow-up screening for surveillance purposes.
Residents who are temporarily transferred to other facilities (e.g., a hospital) do not need to be re-screened upon re-admission, if that facility has a TB prevention and control program in place.
Patients with signs or symptoms of active TB disease
Patients with active TB disease may have 1 or more of the following:
- Prolonged cough (≥ 3 weeks )
- Weight loss
- Night sweats
- Fever, chills
- Poor appetite
- Chest pain
- Other symptoms may be present, depending on the site of disease
Active TB disease most commonly affects the lungs (pulmonary), but approximately 40% of TB cases in Minnesota involve only an extrapulmonary site of disease (most commonly pleural or lymphatic). For infection control purposes, only pulmonary, pleural and laryngeal TB disease are considered potentially infectious; most extrapulmonary TB cannot be transmitted to others.
Any patient with symptoms of infectious active TB disease, regardless of the results of TST or TB blood test, should be transferred to a facility with respiratory isolation rooms and promptly evaluated to exclude a diagnosis of active TB disease. The evaluation should include a medical examination and symptom screen, a chest radiograph, and collection of sputum specimens or additional testing if indicated.
If active TB disease is confirmed or suspected, the diagnosing clinician should notify the Minnesota Department of Health within one working day. The patient must remain in respiratory isolation until TB is diagnosed and effective treatment is initiated, or TB is ruled out. The patient's physician and the public health department should be consulted for guidance regarding when an active TB patient can be considered to be noninfectious.
- The difference between latent TB infection (LTBI) and active TB disease Attention: Non-MDH link