Health Monitoring_TB 02-04_V1.0.doc
Document type: SOP
Document code: TB 02-04
HEALTH MONITORING OF
LABORATORY STAFF
Confidentiality: none
TABLE OF CONTENTS
1.
PURPOSE .................................................................................................................................................. 2
2.
SCOPE ........................................................................................................................................................ 2
3.
RESPONSIBILITIES ............................................................................................................................... 2
4.
CROSS-REFERENCES ......................................................................................................................... 2
5.
PROCEDURES ......................................................................................................................................... 3
5.1. Commencement of employment ......................................................................................... 3
5.2. Quarterly monitoring .......................................................................................................... 3
5.3. Annual monitoring .............................................................................................................. 3
5.4. Post-exposure monitoring ................................................................................................... 3
6.
REFERENCES .......................................................................................................................................... 4
7.
CHANGE HISTORY ................................................................................................................................ 4
8.
ANNEX ........................................................................................................................................................ 5
This SOP template has been developed by FIND for adaption and use in TB laboratories
Release date: ddMMMyy
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Health Monitoring_TB 02-04_V1.0.doc
1.
PURPOSE
This SOP describes the monitoring of the health of all laboratory staff working in the
_______________ TB Laboratory. Laboratory workers are at an increased risk of tuberculosis
compared with the general population. The regular monitoring of staff for tuberculosis exposure is
important for the early identification of staff who may be suffering from tuberculosis. Infected staff who
have not been identified may also infect their co-workers, thereby further spreading the disease.
Regular health monitoring is also important to identify short-falls in procedures set up to minimize risk
of occupational exposure to tuberculosis in the laboratory.
This procedure describes the method of monitoring staff at the commencement of employment, and
for regular monitoring thereafter.
2.
SCOPE
This SOP applies to all personnel working in the _______________ TB Laboratory.
3.
RESPONSIBILITIES
The Head of TB Laboratory is responsible for ensuring all staff undergo pre-employment screening
and regular monitoring in accordance with this SOP. The costs of any testing required as part of this
SOP will be covered by ______________________.
All staff working in the laboratory are responsible for completing the quarterly medical questionnaires
and providing the Head of Laboratory Research with X-ray and tuberculin skin test reports (if
appropriate) as described in this procedure. Staff are required to make themselves aware of the
symptoms of tuberculosis and to promptly be examined by a physician if they display any of the
symptoms.
All staff members working in the _____________________ TB Laboratory are responsible for the
implementation of this SOP. All users of this procedure who do not understand it or are unable to
carry it out as described are responsible for seeking advice from their supervisor.
4.
CROSS-REFERENCES
See:
Document Matrix_ TB 01-01_V1.0.doc
General Safety Procedures_TB 02-01_V1.0.doc
Location:
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Health Monitoring_TB 02-04_V1.0.doc
5.
PROCEDURES
5.1. Commencement of employment
All new staff should receive a chest X-ray, tuberculin skin test (if previously untested or previous test
was negative) and training in safety techniques and procedures, before starting work in the laboratory.
A copy of the chest X-ray report should be retained in the confidential personnel records.
For strongly positive reactors (skin test diameter >15mm) and symptoms suggestive of TB should be
investigated clinically and microbiologically. Two sputum specimens collected on consecutive days
should be investigated for TB by smear microscopy, culture and drug susceptibility testing performed
on any positive cultures.
Confidential HIV testing with pre- and post-test counseling will be offered to all laboratory workers.
Results must be recorded on:
Use:
Health Monitoring Questionnaire_form
Location:
5.2. Quarterly monitoring
All staff must complete the Health Monitoring Questionnaire once every quarter in January, April, July
and October. If the response to any of the questions is “Yes”, the staff member must be referred to
his/her doctor for further investigations.
5.3. Annual monitoring
Chest X-ray and tuberculin skin testing [TST] (if the staff member’s previous test was <10mm) should
be performed annually. In the event of changes on the X-ray or the conversion of the TST, the staff
member should be referred to a physician for further examinations and the Head of the TB Laboratory
should be informed. The chest X-ray report and X-ray films must be kept in the personnel file. In
addition to the annual surveillance, staff must be made aware of the symptoms of TB and must be
promptly examined by a physician if they display any of these symptoms: night sweats, persistent
cough, lethargy and unexplained weight loss.
5.4. Post-exposure monitoring
Following a major aerosol accident, all personnel involved should have their health monitoring file
reviewed. They should be monitored clinically. Eight weeks after exposure, a chest X-ray should be
performed and a TST in cases where the baseline diameter was <10mm.
For more details of laboratory accidents see the General Safety Procedures
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Health Monitoring_TB 02-04_V1.0.doc
Following all major aerosol accidents, a laboratory audit must be undertaken.
Use:
Internal Audit Questionnaire Laboratory_form.doc
Internal Audit Report Laboratory_form.doc
Location:
6.
REFERENCES
World Health Organisation. Laboratory Services in Tuberculosis Control. Part 1. Organisation and
Management. World Health Organisation 1998. WHO/TB/98.258.
7.
CHANGE HISTORY
New version #
/ date
Old version #
/ date
No. of
changes
Description of changes
Source of
change request
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Health Monitoring_TB 02-04_V1.0.doc
8.
ANNEX
Summary of Laboratory Staff Health Monitoring
Pre-employment

Baseline information on BCG and Hepatitis B vaccination

Offer Hepatitis B vaccination where indicated

History of TB disease

Other diseases that may compromise susceptibility to TB

Mantoux test

Chest X-ray

Questionnaire re TB signs and symptoms

Clinical and microbiological follow-up where indicated

Offer HIV testing
Quarterly monitoring

Questionnaire re TB signs and symptoms

Clinical and microbiological follow-up where indicated
Post-exposure monitoring

Clinical monitoring

Chest X-ray and Mantoux test (where baseline <10mm) 8 weeks after exposure
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