Infection Control Manual, TB Evaluation

TB Prevention/Control
	Introduction
	Screening
	Early Identification
	Airborne Precautions
	Discharge Planning
	Prevention & Control:
	Procedure Specific
	TB Surveillance
	PPD Testing
	Unprotected TB Exposure
	Work Restrictions
	Consultation

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Yale New Haven Hospital
QISS
GB 325
New Haven, CT
06504 USA

Dr. Jeff Topal
688-4634

Unprotected Exposure to TB

	In addition to routine tuberculin skin testing, healthcare facility personnel must be evaluated if they have been exposed to a potentially infectious tuberculosis patient for whom Airborne Precautions were not initiated.
	Healthcare personnel who have a documented negative PPD within the 3 months preceding the exposure do not need to have the baseline PPD repeated. However, they should still report to OHS for post-exposure counseling. All other exposed personnel except those previously known to have a positive PPD in the past) should receive a Mantoux tuberculin skin test as soon as possible after the exposure. If the initial skin test is negative, the test should be be repeated 12 weeks after the initial exposure to assess for possible tuberculin skin test conversion secondary to the exposure.
	Exposed persons with tuberculin skin test reactions of greater than or equal to 10mm or with symptoms suggestive of tuberculosis should receive chest radiographs. Persons with previously known positive tuberculin skin tests who have been exposed to an infectious patient do not require a chest radiograph unless they have symptoms of tuberculosis.

Evaluation of Healthcare Facility Personnel with Positive Tuberculin Skin Test Results or Symptoms due to TB

	Healthcare facility personnel with positive tuberculin skin tests or with skin test conversions following an exposure should be clinically evaluated for active TB by OHS or the Winchester Chest Clinic.
	Personnel with symptoms suggestive of tuberculosis should be evaluated in the Winchester Chest Clinic regardless of tuberculin skin test results. If tuberculosis is diagnosed, appropriate therapy should be instituted per published guidelines.
	Personnel with symptoms suggestive of tuberculosis should be evaluated in the Winchester Chest Clinic regardless of tuberculin skin test results. If tuberculosis is diagnosed, appropriate therapy should be instituted per published guidelines.
	Healthcare facility personnel who have positive tuberculin skin test or skin test conversions, but who do not have active disease should be evaluated for prophylactic chemotherapy (i.e. INH prophylaxis) by the Winchester Chest Clinic.
	Occupational Health Services should educate on a regular basis all persons with a history of TB or positive tuberculin skin test that they are at risk for reactivation of TB in the future. Accordingly, they should promptly report any pulmonary symptoms. If symptoms suggestive of tuberculosis develop, the person should be evaluated immediately in the Winchester Chest Clinic.

Routine and Follow-Up Chest Radiographs

Routine chest films are not required for asymptomatic tuberculin skin test negative personnel. After the initial chest radiograph is taken, personnel with a positive skin test (+PPD) do not need repeat chest radiographs unless symptoms develop that are suggestive of active TB.

Last modified: February 27, 2001.