Sec. 10.07.10.15. Tuberculosis Screening

A. Certification of paid and unpaid personnel under Regulation .09E shall occur not later than 10 days after the beginning of service. Certification shall be accomplished in one of the following four ways as specified in §A(1)-(4), of this regulation:

(1) If the individual has documentation of a negative tuberculin test by the Mantoux method within the past 24 months and has, by history, no contact with a person with tuberculosis in a communicable form following this documentation or no symptoms consistent with tuberculosis, the individual shall be considered to be a negative tuberculin reactor and to be free from tuberculosis in a communicable form. Further skin testing is not necessary, except for epidemiologic diagnostic purposes which may be required by the local health officer or the Department.

(2) If the individual does not have documentation of a negative tuberculin test by the Mantoux method within the past 24 months and does not have a history of having had a positive tuberculin test by the Mantoux method, the following procedure shall be done:

(a) Five tuberculin units (TU) of purified protein derivative (PPD) shall be administered intradermally and the results read 48-72 hours following the administration of the test;

(b) An individual with induration of 5-9 millimeters and no history of contact with a person with tuberculosis in a communicable form or an individual with induration of 0-4 millimeters shall be considered to be a negative tuberculin reactor and to be free from tuberculosis in a communicable form;

(c) An individual with induration of 5-9 millimeters and a history of contact with a person with tuberculosis in a communicable form or an individual with induration of 10 millimeters or more shall be considered to be a positive tuberculin reactor and shall be handled as described in §A(3)(a)-(c), of this regulation.

(3) If the individual is a positive tuberculin reactor as defined in §A(2)(c), of this regulation, or if the individual has a history of a positive tuberculin test by the Mantoux method without documentation of having received an adequate course of therapy, as defined by the local health officer, for tuberculosis disease or received adequate prophylaxis, as defined by the local health officer, for tuberculosis infection, the following procedure shall be done:

(a) If the individual does not have documentation of a negative chest X-ray within the past 12 months, the individual shall be evaluated by a chest X-ray. If the chest X-ray is negative, the individual shall be considered to be free from tuberculosis in a communicable form and shall have a repeat chest X-ray in 12 months, unless isoniazid therapy is instituted, in which case the second chest X-ray is unnecessary.

(b) If the individual has documentation of a negative chest X-ray within the past 12 months, the individual shall be considered to be free from tuberculosis in a communicable form and shall have a repeat chest X-ray 12 months after the individual's most recent documented chest X-ray unless isoniazid therapy has been instituted, in which case the second chest X-ray is unnecessary.

(c) If the individual has had two successive negative chest X-rays 12 months apart, no further chest X-rays are necessary and the individual shall be considered to be free from tuberculosis in a communicable form unless the individual has symptoms consistent with tuberculosis.

(4) If the individual has documentation of an adequate course of therapy, approved by the local health officer, for tuberculosis disease or adequate prophylaxis, approved by the local health officer, for tuberculosis infection, further chest X-rays are not necessary and the individual shall be considered to be free from tuberculosis in a communicable form unless the individual has symptoms consistent with tuberculosis.

B. The agency shall instruct each employee and volunteer in the signs and symptoms of active tuberculosis and advise the individual to seek immediate medical care should the individual detect these signs or symptoms.

C. If the individual meets any of the following criteria in this section, the agency shall have written policies and procedures, acceptable to the Department, for the evaluation, management, and surveillance of this individual. The criteria include:

(1) A history of tuberculosis or tuberculosis infection without documentation of adequate treatment as defined and determined by the local health officer;

(2) Current treatment for tuberculosis disease or tuberculosis infection;

(3) Chest X-rays consistent with tuberculosis without documentation of adequate treatment as defined and determined by the local health officer; or

(4) Symptoms consistent with tuberculosis or a history of contact with a person with tuberculosis in a communicable form within the past 12 months.

D. The following records shall be maintained by the agency:

(1) Results of Mantoux tests, recorded in millimeters of induration with dates of administration, dates of reading, and results of tests;

(2) Results of X-rays required in §A(3)(a)-(c), of this regulation; and

(3) Documentation of any Mantoux test, chest X-ray, chemotherapy, and chemoprophylaxis which is the basis for the certification that the individual is free from tuberculosis in a communicable form.