Low-risk hospitals reduce TB screening, but should remain vigilant

January 12th, 2015

Hospitals that have reduced tuberculosis screening for health care workers should remain vigilant for disease introductions and take heed of the following cautionary tale.

In 2005, the Centers for Disease Control and Prevention issued guidelines that advised health care facilities to conduct an annual risk assessment for TB. Low-risk facilities – defined as fewer than three TB cases a year in hospitals of less than 200 beds and fewer than six in hospitals of 200 beds or more – do not need to conduct annual screening. They provide baseline testing and annual symptom screens for employees with previous positive tests.

Thereafter many low risk hospitals ended annual TB screening programs, though health care workers may still still receive information about TB in infection control annual in-servicing.

As hospitals limit their TB screening programs, however, there is one caveat: TB risk might not always remain at a low level.

At the Marshfield (WI) Clinic, Bruce Cunha, RN, MS, COHN-S, manager of employee health and safety, enjoyed the staff time he gained by ending the skin testing program. But then in 2012, the main clinic facility saw three patients with tuberculosis, which put it in the moderate risk category.

Even worse, two of those cases were not promptly reported to employee health, so there was no opportunity to assess who may have been exposed and to target TB screening. Cunha is now gearing up to test 2,500 employees using the QuantiFERON-TB Gold test, one of two available blood tests.

“If you know who was exposed, you can break down your risk by department,” he says. “Unfortunately, now we’re at a point where we have to test everyone.”

Cunha’s advice: Maintain the ability to ramp up your screening program, if necessary. Even a low-risk facility can see the occasional TB patient.

“I would recommend having a contingency plan in place,” he says.<

--Michele Marill