Tuberculosis (TB) Screening of Residents in Nursing Homes and Boarding Care Homes
| Tuberculin Shortage - April 30, 2013 MDH recommendations. |
Routine TB screening of patients is not required in Minnesota health care settings except for those settings with an elevated risk for TB transmission, including boarding care facilities, correctional facilities, and nursing homes.
Patients in other facilities may be screened for TB at the discretion of their health care providers or the health care setting's infection control team.
On this page:
Baseline TB Screening for Patients
Special Situations:
Patient with Newly Identified Positive TST or TB Blood Test Result
Patient with Written Documentation of Previous Positive TST or TB Blood Test
Patient with Verbal (Undocumented) History of Previous Positive TST or TB Blood Test
Patient with a Documented History of Prior Treatment for Latent TB Infection (LTBI) or Active TB Disease
Patients with Signs or Symptoms of Active TB Disease
Patients with Previous History of Severe Adverse Reaction to TST
Baseline TB Screening for Patients
Baseline TB Screening Tool for Patients (Word: 69KB/2 pages)
All residents must receive baseline TB screening within 72 hours of admission or within 3 months prior to admission. Baseline TB screening consists of three components: (1) assessing the patient's risk factors for TB, (2) assessing for current symptoms of active TB disease, and (3) testing for the presence of infection with Mycobacterium tuberculosis by administering either a two-step TST or single TB blood test.
A patient's history of BCG vaccination should be disregarded when administering and interpreting TST results.
Written documentation (including the dates and results) of all pertinent TB testing and evaluations should be easily accessible in the patient’s medical record.
Patients with negative baseline TB testing do not need periodic follow-up testing for surveillance purposes.
Residents who are temporarily transferred to other facilities (e.g., a hospital) do not need to be re-tested upon re-admission, if that facility has a TB prevention and control program in place.
Additional information about baseline TB screening can be found on pages 28-32 of "Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005."
Special Situations:
Patients with a newly identified positive TST or TB blood test
These patients should receive a medical examination and a chest radiograph to exclude a diagnosis of active infectious TB disease. If the patient is diagnosed with latent TB infection (LTBI), treatment to prevent the progression to active TB disease should be considered. After the baseline chest radiograph is performed and the negative result is documented, repeat chest radiographs are not needed unless symptoms or signs of active TB disease develop or a clinician recommends a repeat chest radiograph.
Patients with written documentation of previous positive TST or TB blood test
TST documentation should include the exact date, the number of mm of induration, and interpretation. If the date and mm induration cannot be obtained, documentation of a history of infection with TB (e.g., a positive skin test in the past) by a physician in the patient’s medical record is acceptable.
These patients do not need a TST or TB blood test but do need to be assessed for current TB symptoms and risk factors for progression to active TB disease within 72 hours of admission or within 3 months prior to admission. These patients also need to have a chest radiograph result indicating no active TB disease on file that is dated after the date of the positive TST or TB blood test (i.e., baseline chest radiograph). After the baseline chest radiograph is performed and the negative result is documented, repeat radiographs are not needed unless symptoms or signs of active TB disease develop or a physician recommends a repeat chest radiograph.
Any patient with symptoms of infectious TB disease 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. Asymptomatic patients with risk factors for progression to active TB disease may be evaluated for active TB at the discretion of their physician or the setting’s infection control team.
Patients with a verbal (undocumented) history of a previous positive TST or TB blood test
These patients must undergo the same screening process as patients without previous positive results.
Patients with a documented history of prior treatment for latent TB infection (LTBI) or active TB disease
These patients do not need a TST or TB blood test but do need to be assessed for current TB symptoms and risk factors for progression to active TB disease within 72 hours of admission or within 3 months prior to admission. Patients with a history of treated LTBI also need to have a chest radiograph result indicating no active TB disease on file that is dated after the date of the positive TST or TB blood test (i.e., baseline chest radiograph). After the baseline chest radiograph is performed and the negative result is documented, repeat radiographs are not needed unless symptoms or signs of TB disease develop or a physician recommends a repeat chest radiograph. Consultation is available from the MDH TB Prevention and Control Program (651-201-5414) regarding patients with a history of previous active TB disease.
Any patient with symptoms of infectious TB disease 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. Asymptomatic patients with risk factors for progression to active TB disease may be evaluated for active TB disease at the discretion of their physician or the setting’s infection control team.
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 )
- Hemoptysis
- Weight loss
- Night sweats
- Fatigue
- 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 the 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
Patients with previous history of severe adverse reaction to TST
Any patient who provides a convincing verbal report of a severe adverse reaction to a TST, even if the reaction is not documented, should NOT receive a TST. Substitute a TB blood test for the TST if it is available in your area. If the TB blood test is not available in your area, document the severe reaction and conduct the TB symptom screen.
