On May 17, 2019, the Centers for Disease Control and Prevention (CDC) published updated guidelines for Tuberculosis (TB) screening, testing and treatment of health care workers. It is no longer recommended that medium-risk health care facilities conduct annual TB testing using the TST or IGRA. However, health care facilities must still complete an annual health care facility risk assessment as described in the 2005 guidelines to inform their infection control policies and procedures. Regarding screening and testing of health care workers, the updated 2019 guidelines include the following recommendations:
- Conduct a baseline screening, including and individual risk assessment and testing of new employees upon hire;
- Ongoing serial testing (i.e. annually) is not recommended;
- Repeat testing is recommended if TB exposure (without use of appropriate PPE) is suspected;
- Health care personnel with latent TB infection (LTBI) are to be offered and encouraged to undergo treatment;
- Low-risk personnel who have a newly-positive test are to be assessed for TB infection including symptom evaluation and a chest radiograph;
- Health care personnel who have had a prior positive test are to be evaluated for symptoms, and if they have a documented normal chest radiograph, they are not required to have a repeat radiograph unless they are symptomatic or starting LTBI treatment;
- Personnel LTBI who do not complete treatment are to have an annual symptom screening and education regarding LTBI treatment; and
- Annual education for all staff regarding signs and symptoms of TB disease.
Baseline individual risk assessment includes asking questions regarding time spent of > 1 month in countries other than the U.S., Australia, Canada, New Zealand, the United States, and those in western or northern Europe; immunosuppression; and known exposure to someone with active infection. Symptoms of pulmonary TB include but are not limited to a bad cough that lasts three weeks or longer, pain in the chest, and coughing up blood or sputum. Other non-specific symptoms may include weakness or fatigue, weight loss, no appetite, chills, fever, and sweating at night. CDC has created a FAQ regarding the new guidelines in addition to an individual risk assessment form. For more information, please visit the CDC TB webpages.