All healthcare facility personnel will receive a Mantoux intradermal tuberculin skin test on employment and before patient care contact is initiated unless a previously positive reaction, completion of adequate prophylactic chemotherapy, or completion of an adequate therapeutic regimen for active disease can be clearly documented.
	Previous vaccination with Bacillus Calmette-Guerin (BCG) is not a contraindication for tuberculin skin testing. Such individuals should undergo skin testing unless a recently positive skin test can be documented. A two-step tuberculin screening test will be used in all new employees who have not had a documented recent tuberculin test within the past 12 months.
	Initial and follow-up tuberculin skin tests should be administered and interpreted collaboratively by the staff of Occupational Health Services and the Winchester Chest Clinic according to the established guidelines of the CDC and the American Thoracic Society.
	Healthcare facility personnel with a documented history of a positive tuberculin skin test, completion of adequate treatment for active disease, or completion of prophylactic chemotherapy for infection should be exempt from further routine tuberculin skin test screening. After an initial chest radiograph is obtained, personnel with a positive tuberculin skin test do not need repeat radiographs unless symptoms develop suggestive of active tuberculosis.
	Periodic retesting of PPD-negative healthcare workers will be conducted at a minimum on an annual basis to identify persons whose skin tests convert to positive. Such individuals have a 10% lifetime risk of reactivation of TB which is greatest in the first two years after conversion. Thus, the identification of such individuals and the appropriate use of prophylactic chemotherapy would prevent the development of active disease and possible nosocomial transmission to patients and other workers.
	The frequency of repeat testing should be based on the risk of developing new infection. Thus, those frequently exposed to patients with tuberculosis or who are involved in potentially high-risk procedures (i.e. bronchoscopy, sputum induction, or aerosol treatments given to patients who may have tuberculosis) should be retested at least every 6 months.
	Failure to comply with Occupational Health Services requests for tuberculin skin testing and/or follow-up will be considered grounds for administrative action, including potential dismissal, as outlined in the administrative policy of Yale-New Haven Hospital.