What health care workers need to know about TB screening
All health care workers in the United States must be screened for TB before being hired. TB screening includes the following:
- TB risk assessment
- TB symptom evaluation
- A TB test (e.g., TB blood test or a TB skin test)
- Additional evaluation as needed
TB risk assessment
The risk assessment information helps to interpret the TB test results more accurately. In order to perform the assessment, three questions should be answered about Health Care Personnel:
- Is the applicant temporarily or permanently in a country with a high TB rate?
- Is his/her immune system weakened?
- Has he been in close contact with a person with TB since the last tuberculosis test?
Some of the factors that lead to a weakened immune system are:
- Human immunodeficiency virus (HIV) infection
- Organ transplant recipient
- Treatment with a TNF-alpha antagonist (e.g., infliximab)
- Chronic steroid therapy
- Use of other immunosuppressive medications
TB symptom evaluation
The symptoms of tuberculosis depend on where the bacteria grow in the body. This bacterium usually grows in the lungs. Lung infection causes the following symptoms:
- Coughs that last more than three weeks
- Chest pain
- Coughing up blood or sputum
Other symptoms include:
- Fatigue
- Anorexia
- Unexplained Weight Loss
- Night sweats
- Fever and chills
TB tests
TB test is performed in two ways: TB skin test and TB blood test. TB skin test is performed in two stages:
- First, a small amount of a fluid called tuberculin is injected under the skin on the lower part of the arm.
- Then, after 48 to 72 hours, the trained health care worker examines the injection site’s reaction.
If the result is positive, further evaluations should be performed to determine whether the TB is latent or active.
Remember that if necessary, repeating the TB skin test is safe; the only thing to note is that the test should be repeated on your other arm.
Types of TB blood test are:
TB blood tests are usually performed on people who:
- have received the TB vaccine
- have a difficult time returning for a second appointment
If the TB blood test is positive, other tests should be done to determine if the infection is active or latent.
Annual screening, testing, and education
Remember that people with latent TB infection have no symptoms and cannot spread the infection to others. Health care personnel with positive test results should do a chest x-ray and other evaluations to rule out infection.
Annual TB testing is not recommended for health care personnel. Health care workers with untreated latent TB infection should receive an annual TB symptom screen. Some groups (such as pulmonologists or respiratory therapists) that are more at occupational risk for TB may need annual TB screening. In general, employees should follow state and local health departments’ recommendations to decide on annual TB screening.
Besides, all employees must receive TB education annually. These educations should focus on the following:
- TB risk factors
- Signs and symptoms of TB disease
- TB infection control policies
Employees with known exposure to TB should receive a TB symptom screen:
- A person with a previous negative test result should be tested immediately and re-tested 8 to 10 weeks after the last known exposure.
- A person with a history of positive test result does not need to be re-tested after TB exposure. This person should first have a TB symptom screen if he/she has TB symptoms, he/she should be evaluated for TB disease.
You may be wondering why not get vaccinated to prevent TB. The Calmette-Guerin (BCG) vaccine is currently very effective in preventing tuberculosis in children, but unfortunately, it is not necessarily very effective in adults. Therefore, vaccination in adults cannot be considered as part of screening.
Let’s sum up
Without treatment, tuberculosis would be a fatal disease. If active TB is not treated, the infection can spread from the lungs to the bloodstream and other parts of the body. Therefore, TB screening is a reasonable tool to prevent such complications. You should do this screening if you have a risk factor that puts you at higher risk for TB.
We have prepared the content of this article based on the questions asked by most of our clients. If you have any questions about the matter above, please do not hesitate to contact us.
