Best practices for employing health care personnel




Tuberculosis (TB) screening, testing, and educationedit

Based on recommendations from The Center for Disease Control and Prevention (CDC) for TB screening and testing the following best practices should be followed when hiring and employing Health Care Personnel.

Initial hiring processedit

When hiring Health Care Personnel, the applicant should complete the following:

  1. a TB risk assessment
  2. a TB symptom evaluation for at least those listed on the Signs & Symptoms page
  3. a TB test in accordance with the guidelines for Testing for TB Infection
  4. Additional evaluation for TB disease as needed (e.g. chest x-ray for HCP with a positive TB test)

Recommended testing proceduresedit

The CDC recommends either a blood test, also known as an interferon-gamma release assay (IGRA), or a skin test, also known as a Mantoux tuberculin skin test (TST). It is not the intention of this article to explore the protocol of carrying out a proper TB test. A TB blood test for baseline testing does not require two-step testing. If the skin test method is used to test HCP upon hire, then two-step testing should be used. A one-step test is not recommended.

Two-step testingedit

The CDC has outlined further specifics on recommended testing for several scenarios. In summary:

  1. Previous documented positive skin test (TST) then a further TST is not recommended
  2. Previous documented negative TST within 12 months before employment OR at least two (2) documented negative TSTs ever then a single TST is recommended
  3. All other scenarios, with the exception of programs using blood tests, the recommended testing is a two-step TST

According to these recommended testing guidelines any two negative TST results within 12 months of each other constitute a two-step TST.

Annual screening, testing, and educationedit

  1. The only recurring requirement for all HCP is to receive TB education annually. While the CDC offers education materials there is not a well defined requirement as to what constitutes a satisfactory annual education.
  2. Annual TB testing is no longer recommended unless there is a known exposure or ongoing transmission at a healthcare facility.
  3. Should an HCP be considered at increased occupational risk for TB annual screening may be considered.
  4. For HCP with a documented history of a positive TB test result do not need to be re-tested but should instead complete a TB symptom evaluation. It is assumed that any HCP who has undergone a chest x-ray test has had a previous positive test result.

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