Wayne ARC Tuberculosis Control Policy
Effective date: June 1, 2010
A. The Wayne ARC Tuberculosis Control Policy is in accordance with:
14 NYCRR Section 633.14 for facilities certified by OMRDD
NYS OFCS Bureau of Early Childhood Services 418.1 for RCC
NYS DOH Bureau of Early Intervention 4.1 for RCC
B. Definitions:
The following definitions are applicable to this policy:
1. Employee: An employee, full, part-time, temporary, relief or substitute.
2. Non-employee: Include foster grandparents, senior companions, volunteers, interns,
experiential learners, personal aides and any other person deemed appropriate.
3. Consultant: A party subject to a contractual arrangement with Wayne ARC to perform a
service in exchange for financial or other consideration and who will be reasonably
anticipated to have direct contact with service recipients.
4. AFB smears and cultures: Laboratory tests used to determine the presence or absence
of an active mycobacterium tuberculosis infection. They are used to help determine
whether tuberculosis (TB) is confined to the lungs or has spread to organs outside the
lungs.
5. Active pulmonary tuberculosis: A contagious disease of the lungs that is confirmed by
culture to be caused by the microorganism mycobacterium tuberculosis.
6. Possible tuberculosis infection: Someone demonstrating a significant reaction to a TB
test, but who has no signs or symptoms of active pulmonary TB and no TB organisms are
found in the sputum.
7. Mycobacterium tuberculosis: The bacterium that causes most cases of tuberculosis.
8. Purified Protein Derivative (PPD): A purified protein derivative used in the tuberculin
skin test.
9. Service provider: A program of Wayne ARC.
10. Service recipient: A person receiving services from Wayne ARC.
11. Suspected active pulmonary tuberculosis: A condition in which a person either
exhibits the clinical signs and symptoms of active pulmonary TB or has a significant
reaction to a TB test and is awaiting the results of diagnostic testing.
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12. Tuberculosis (TB) testing: Screening for tuberculosis infection utilizing a test currently
approved by the United States Food and Drug Administration (FDA) and/or
recommended by the Centers for Disease Control (CDC).
13. Tuberculin Skin Test: A test which involves the introduction of a purified protein
derivative (PPD) into the skin by intradermal injection and which is read in millimeters of
induration within 48-72 hours.
14. Two-step PPD: A procedure performed to rule out the presence of an anamnestic
response in people who were infected with tuberculosis in the past. (An anamnestic
response is one in which an initial negative tuberculin skin test triggers an immune
response, resulting in a positive tuberculin skin test.) There is a one (1) to three (3) week
interval between the first and the second PPD.
C. Testing for TB:
1. Initial testing:
i.
All employees, non-employees and consultants shall have tuberculin skin test
complete prior to their first day of employment or service provision. If an initial
tuberculin skin test is performed, it shall be conducted employing a two-step PPD
unless the person has documented evidence of a tuberculin skin test within the last
twelve (12) months. If using the two-step PPD, individuals may begin work if the
first tuberculin skin test is negative.
All medical pre-employment testing will be done at Occupational Medicine/
Employee Health located in Clifton Springs Hospital at 2 Coulter Road, Clifton
Springs, New York. The agency will pay the full cost of the pre-employment
testing.
ii.
An employee, non-employee or consultant may select testing by his/her health
care provider. The employee, non-employee or consultant will be responsible for
the cost of the pre-employment testing, if he/she chooses another health care
provider. The results of the tuberculin skin test and any necessary follow-up
evaluations must be documented and shared with Wayne ARC prior to or on the
first day of employment, service provision or receipt of services.
iii.
Wayne ARC agency nurses will provide free of charge all tuberculin skin test for
employees, non-employees and consultants after their first day of employment.
If using the two-step PPD, the second tuberculin skin test must be completed one
(1) to three (3) weeks after the first tuberculin skin test. Refusal will be
considered out of compliance, which will result in agency action.
iv.
All service recipients shall either provide proof of a tuberculin skin test within the
last twelve (12) months or be assessed for signs and symptoms of active
pulmonary TB on or prior to their first day of receipt of service. A tuberculin skin
test must be carried out within seven (7) days from the first day of receipt of
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service. If the service recipient does not have document proof of a tuberculin skin
test within the last twelve (12) months, the two-step PPD skin test is required.
There is a one (1) to three (3) week interval between the first and second PPD
skin test.
2. Annual testing for Wayne ARC Service Providers and Service Recipients for all facilities
except RCC:
i.
Annual testing is not required.
ii.
Follow-up TB test only if the person is exposed to TB or the person exhibits TB
symptoms.
3. Annual testing for Wayne ARC Service Providers providing services at RCC:
i.
Annual testing is required. This will be provided by Wayne ARC agency nurses.
ii.
Annual health review to be conducted for individuals that meet the criteria for
“Exclusion/contradictions for TB testing”.
4. Exposure testing:
i.
Testing shall be conducted for all service recipients, employees, non-employees
and contractors who are exposed to someone with a suspected or confirmed case
of active pulmonary TB. Such exposure testing will be conducted in cooperation
with the state and local health departments.
D. Exclusions/contraindications for TB testing:
1. The only allowable exclusion from either pre-employment/pre-receipt, pre-delivery of
services or follow-up tuberculin skin test is a documentation of one of the following
reasons for contraindication:
i.
prior documented significant reaction to the TB testing; or
ii.
adequate treatment for active pulmonary tuberculosis; or
iii.
completion of adequate preventive therapy.
2. A statement by a physician, nurse practitioner or physician’s assistant of contraindication
shall be acceptable as long as the statement includes:
i.
a recommendation as to when and if testing would be appropriate at a designated
point in the future;
ii.
how the person will be evaluated for active pulmonary tuberculosis in the interim.
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3. People excluded from TB testing will be evaluated. A registered nurse shall conduct a
general evaluation of the person taking into account any present symptomatology and
history since the person’s previous TB test or evaluation. Based on such evaluation the
nurse may refer the person to local health care provider knowledgeable in the diagnosis
of TB for a formal diagnostic evaluation to exclude active pulmonary TB. Routine chest
x-ray examinations are not required.
4. Prior vaccination with Bacillus of Calmette and Guerin (BCG) is not a contraindication
for TB testing. Results are interpreted in the same manner as for someone who has not
been immunized.
5. Evaluation of a person excluded from tuberculin skin testing who has been exposed to
someone with a suspected or confirmed case of active pulmonary tuberculosis. Such
person shall be referred to the state and local health departments for appropriate postexposure evaluation.
E. Performance and interpretation of TB testing:
1. TB testing shall be performed in accordance with generally accepted community practice
in the fields of medicine and nursing.
2. If an initial tuberculin skin test is performed, it shall be conducted employing a two-step
PPD unless the person has documented evidence of a tuberculin skin test within the last
twelve (12) months.
3. The reading of the tuberculin skin test shall be performed between 48 and 72 hours after
placement by one of the following: physician, physician’s assistant, nurse practitioner,
registered nurse or licensed practical nurse. Interpretation of the tuberculin skin test may
only be done by a physician, physician’s assistant, nurse practitioner or registered nurse.
4. Documented PPD test results shall be retained by Wayne ARC. Documentation shall
include the date tested, the testing method used, and the results of the test and the
interpretation of the test. Documentation shall also include the testing material used, the
site of implantation, the date of reading and the size of the reaction in induration in
millimeters.
F. Evaluation of those with significant reaction:
Any person with a significant reaction and/or test results interpreted to indication
possible TB infection shall be immediately be referred to a health care provider
knowledgeable in the diagnosis of TB for a formal diagnostic evaluation to exclude
active pulmonary TB.
1. If the initial testing shows a significant reaction and/or test results interpreted to indicate
possible TB infection, the person shall not be allowed to begin employment/service
provision until the following criteria is met:
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i.
the person is evaluated by a health care provider and found to be free of active
pulmonary TB or the person meets the following criteria:
a. adequate treatment is instituted; and
b. the cough resolved; and
c. sputum specimens are negative on three (3) consecutive AFB smears
2. If annual testing and/or exposure testing shows a significant reaction and/or a test result
interpreted to indicate possible TB infection, the person shall be assessed by the
registered nurse, physician, physician’s assistant or nurse practitioner for signs/symptoms
of active pulmonary TB.
i.
Employees, non-employees and consultants without signs/symptoms of active
pulmonary TB may continue to work but must be evaluated within five (5) days.
If the evaluation is not completed within five (5) days, the person will not be
allowed to work or provide services until such evaluation is complete and he/she
has met the criteria specified in subparagraph (1)(i) of this subdivision.
Employees, non-employees and consultants with signs/symptoms of active
pulmonary TB shall be immediately excluded from working or providing
services. These people will not be allowed to work or provide services until they
have met the criteria specified in subparagraph (1)(i) of this subdivision.
ii.
Recipients of services without signs/symptoms of active pulmonary TB may
continue his/her normal activities including day program and must be evaluated
within five (5) days. If the evaluation is not completed within five (5) days, the
person shall be confined to his/her room, to the extent possible, until such
evaluation is complete and he/she has met the criteria specified in subparagraph
(1)(i) of this subdivision.
Recipients of services with signs and symptoms of active pulmonary TB are to be
immediately transported to the nearest acute care facility (e.g. emergency room)
for evaluation and treatment.
G. Maintaining compliance:
1. TB testing or evaluation for active TB shall be mandatory.
i.
Refusal by employees, non-employees and consultants to be tested or evaluated
for active TB shall be considered out of compliance, which will result in agency
action.
ii.
Refusal by service recipients to be tested or evaluated for active pulmonary TB
shall be considered out of compliance and this will affect receipt of services from
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Wayne ARC. (This provision does not include those service recipients who are
making a good faith effort to comply with testing requirements.)
H. Cooperation and coordination with public health authorities:
1. Each suspected or confirmed case of active pulmonary TB shall be reported to the local
health department and to OMRDD within 24 hours.
2. The service provider and OMRDD will coordinate efforts related to contact investigation,
testing and care of the affected person with appropriate local health department and the
New York State Department of Health.
I. Tuberculosis control plan and register:
1. Wayne ARC shall have a TB control plan which includes:
i.
Training to be conducted initially upon employment and annually thereafter for
employees on the signs and symptoms of active pulmonary TB and information
on Wayne ARC’s policies and procedures;
ii.
Ensuring that employees and service recipients are appropriately tested and
evaluated for active pulmonary TB; and
iii.
Maintaining documentation of testing.
2. Wayne ARC shall document all suspected or confirmed cases of active pulmonary TB,
including maintenance of register of:
i.
All known or suspected TB cases, including the results of tests, x-rays and
treatments carried out and reports of suspected or confirmed active pulmonary TB
made to the state and local health departments;
ii.
The results of TB testing noting positive reactions and people who have received
or are receiving preventive therapy or treatments for active pulmonary TB.
3. A summary of total TB test results shall be maintained at a location designated by each
service provider for employees, non-employees, consultants and service recipients.
Attached forms:
Form A –
Form B –
Form C –
Employee Tuberculosis Testing
Evaluation for Signs & Symptoms of Active Pulmonary Tuberculosis for
Service Recipients
Evaluation for Signs & Symptoms of Active Pulmonary Tuberculosis for
Service Recipients
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