Shiawassee County Medical Care Facility
Tuberculosis Surveillance
Policy Statement
Residents will be screened for M. tuberculosis infections upon their admission to the facility and at
intervals appropriate for the regional prevalence of tuberculosis, with screening to be performed at least
annually.
Policy Interpretation and Implementation
1.
Upon admission to the facility the resident will be assessed for M. tuberculosis infection (Twostep Mantoux test).
2. During the initial history and physical, assess the resident for signs and symptoms generally
associated with pulmonary tuberculosis:
a. Fatigue;
b. Fever;
c. Weight loss;
d. Night sweats; and
e. Cough or hemoptysis.
3. A chest x-ray will be obtained within seventy-two (72) hours if signs of tuberculosis are present,
regardless of previous x-ray results or the skin test reaction, if performed.
4. If the Purified Protein Derivative Standard (PPD) status resident was known to have been positive
in the past, obtain a chest x-ray if written documentation of chest x-ray is not available from chest
x-rays taken within the past two (2) years, or if the resident has signs and symptoms associated
with pulmonary tuberculosis.
5. If the PPD status is unknown, or is known to have been negative in the past, 0.1 ml of 5
Tuberculin Units (5 TU) PPD will be administered intradermally on the inner aspect of the right
forearm, to form a wheal of 6–10 mm. Disregard BCG history.
6. Read the test in forty-eight (48) to seventy-two (72) hours. The following criteria will be used
regardless of previous administration of BCG vaccine:
a. Negative—less than 10 mm induration;
b. Positive—equal to or greater than 10 mm induration.
7. If the chest x-ray returns with abnormal reading in a new admission, place the resident on
Airborne Isolation Precautions in a private room with the door closed and an exhaust fan in the
window to provide negative pressure. Maintain isolation until sputum specimens sent for acid-fast
bacilli (AFB) return negative.
8. Obtain sputum specimen for AFB on residents with abnormal chest x-rays and/or symptoms
associated with pulmonary tuberculosis. Place residents with sputum specimens positive for AFB
in a private room with the door closed and an exhaust fan in the window to provide negative
pressure.
9. Assess all PPD positive residents annually for signs and symptoms associated with pulmonary
tuberculosis. If they develop a persistent cough (more than three (3) weeks) or have prolonged
unexplained fever or other symptoms compatible with pulmonary tuberculosis, obtain chest x-ray.
10. Perform PPD testing on persons with negative PPD at a frequency determined by the needs of the
facility. Assess skin test converters. Obtain chest x-ray on new (with twenty-four (24) months)
skin test converter. In a new skin test converter without known exposure, investigation for the
index cases is indicated. Contact the local health department for guidance.
11. To perform search for index case, perform chest x-rays on known PPD reactors and obtain sputum
specimens for AFB on residents with a cough.
12. When a resident is diagnosed as having pulmonary tuberculosis, especially associated with sputum
smear positive for AFB and with productive cough, perform skin test with 0.1 ml of 5 TU PPD on
persons with history of negative PPD who were contacts of index case at the time of discovery.
Repeat testing in ten (10) to twelve (12) weeks after the exposure. The following criteria will be
used regardless of previous administration of BCG vaccine:
D:\106736846.doc
Shiawassee County Medical Care Facility
a. Negative—less than 5 mm induration;
b. Positive—equal to or greater than 5 mm induration.
13. Observe persons who are known PPD reactors for signs and symptoms associated with pulmonary
tuberculosis following exposure to a diagnosed case.
14. Report cases and converters to the local health department as required.
15. See Management of a Suspect/Case of Tuberculosis in this chapter for policies and procedures
governing a suspected case of tuberculosis.
Regulatory Reference Sources
42 CFR References
Survey Tag #s
Other
Policy/Procedures
Reviewed/Revised
Date: _____ By: _____
Date: _____ By: _____
Date: ______ By: ______
D:\106736846.doc
483.65(a)
F441
MDS Version 2.0 Section I (i)
CDC’s Guidelines for Preventing the Transmission of
Mycobacterium Tuberculosis in Health-Care Facilities