Tuberculosis Testing: From Routine to Risk-Based Screening for Home Care and Hospice Staff.

February 2017 Home Healthcare Now 121 who was infected with TB in the past has a TST placed years after being infected. Because their body is so used to living with TB infection, when an initial TST is placed, the person’s immune system does not react. However, if a second TST is placed it “boosts” the person’s immune system and a positive reaction will result. This positive reaction is an old infection and does not represent a recent infection. The baseline TB test results obtained can then be compared with later TB tests to help identify a recent work exposure and determine if recent TB transmission has occurred. Staff with abnormal TB screening results must receive follow-up medical evaluation according to current Centers for Disease Control and Prevention (CDC) recommendations for the diagnosis of TB (CDC, 2005). If a person has documentation of a prior positive TB test and/or completion of TB therapy, he or she does not need to repeat a TB test. Instead, a symptom screen should be administered on hire and annually, and if symptomatic, a chest x-ray should be completed. If the person cannot provide documentation of a positive TB test and/ or completion of TB therapy, it is appropriate to administer another TB test. The frequency for serial TB screening is determined by state regulations or the outcome of a TB risk assessment. Unless the state’s regulations require that annual TB testing be performed, the frequency for ongoing TB testing should be based on a risk-based screening method. Risk-based screening is a method to determine how frequently the home care and hospice staff should receive a TB test based on their level of risk. An annual TB risk assessment must be completed and be based on risk factors such as the number of TB cases Tuberculosis Testing: From Routine to Risk-Based Screening for Home Care and Hospice Staff