AGING AND DISABILITY SERVICES ADMINISTRATION

 

November 1, 2001

 

AASA:? BH #2001-023
Tuberculosis Screening

 

Dear Boarding Home Provider:

The purpose of this letter is to clarify the requirements for tuberculosis (TB) screening for boarding home staff and ensure that the screening requirements are applied consistently across Residential Care Services (RCS) programs.? ??????????????

Information about TB screening and infection

The purpose of TB skin testing is to identify persons who may have TB disease.? However, a positive TB skin test does not mean that a person definitely has TB disease.? Many persons with positive skin tests are simply infected with TB germs, or have been exposed to TB germs, but do not have any active disease.? A positive TB skin test needs to be followed by other tests, such as chest x-ray, to determine whether a person has active disease.?

Who Sets the Standards and Guidelines for TB Screening?

RCS looks to the Washington State Department of Health (DOH), TB Control Program, for guidance on TB standards and also consults with the Department of Labor and Industries (L&I) to make sure that our regulations are consistent with the Washington Industrial Safety & Health Act (WISHA).?

BH Rules for TB Screening

The BH rule for TB screening of staff is found in WAC 388-78A-050(2) and the beginning of this rules states:

?The licensee shall, in addition to following WISHA requirements, protect residents from tuberculosis by requiring each staff person to have, upon employment: (a) A tuberculin skin test by the Mantoux method, unless?..?.

After consultation with DOH and L&I we have determined that a reasonable interpretation of ?upon employment? is that TB skin testing must be initiated within 3? days of employment.? Beginning with the date of this letter, licensors will be use ?within 3 days? as the standard for when you must initiate TB screening for your new employees.? In the future, we will amend our rules and use the ?within 3 days? language.?

Using the ?within 3 days? standard to initiate TB screening of new staff should not place residents or other staff at greater risk of contracting tuberculosis because generally, infection with TB requires extended periods of close contact for at least several hours per day over the course of a few weeks.? However, to ensure the health and safety of your residents, it is very important that you follow WAC 388-78A-050(3) carefully regarding follow-up on any positive TB tests.? We remind you that your local health department is one place where your staff can go to have their TB tests given, read, and followed up if follow up is necessary.?

If you have questions about this information in this letter, please contact your Field Manager.

Sincerely,

Patricia K. Lashway, Director
Residential Care Services