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New TB requirements—ACTION NEEDED

By Doug Beardsley  |  June 21, 2019  |  All providers




Three important changes regarding Tuberculosis (TB) requirements for licensed nursing facilities, licensed boarding care homes, and licensed home care providers happened simultaneously last week, and they all are effective immediately and require action:

1. The Centers for Disease Control & Prevention (CDC), and subsequently the Minnesota Department of Health (MDH), issued an alert noting a nationwide shortage of APLISOL®, one of the two approved antigens used to perform tuberculin skin tests (TSTs)
   1. As a result of the shortage, certain recommendations regarding TB testing have been published
2. MDH released their annual county TB statistics—this data is used by licensed facilities/providers to update their community-wide TB risk assessment; the updated data and risk assessment instructions and form are available here
   1. Surveyors will ask to see your risk assessment to verify it has been updated, so make sure this task gets completed by the staff member you have assigned to oversee your TB prevention program! 
   2. A separate risk assessment worksheet is required for each licensed facility and for each different physical address—this form has excellent additional instructions regarding how to keep your TB program compliant with the NEW (May 2019) CDC TB Recommendations
3. Based on the new CDC recommendations, healthcare workers in nursing facilities will no longer be required to have annual (serial) TB screening—so long annual TB tests! 
   1. Exceptions exist for those with increased occupational risk and post-exposure

Action steps—What do these changes mean to your licensed program?

1. Update your community-wide TB risk assessment, using the new county data (MDH requirement)—your risk classification results should drive the level of infection control measures employed by the organization
2. Nursing facilities should stop conducting annual (serial) TB testing (TSTs and/or IGRA tests) (CDC update)
3. Investigate the availability and cost of interferon gamma release assay (IGRA)TB blood test screens, as the CDC now recommends (but does not require) them over TST tests (CDC update)
4. If you use TST as your TB screening method for newly hired healthcare workers, you may experience a shortage of the tuberculin antigen used for TSTs—if this occurs, both MDH and the CDC recommend the following:
   
   1. Conduct TB symptom screen—A suggested symptom screening tool can be found here (MDH is in the process of updating this screening tool to match the new CDC recommendations—so ignore the out-of-date sections of the tool)
   2. If tuberculin supply is low, defer second step TST until shortage resolves
   3. If not able to obtain any tuberculin, use IGRA if available; deferring a TB test because tuberculin is not available is not acceptable if you are able to have an IGRA test completed—cost of the IGRA will not be a valid excuse for failing to properly screen
5. If you are a nursing facility or boarding care home, if you use TST as your TB screening method for newly-admitted residents, you may experience a shortage of the tuberculin antigen used for TSTs—if this occurs, both MDH and the CDC recommend the following:
   1. Conduct a TB symptom screen
   2. If tuberculin supply is low, defer second step TST until shortage resolves
   3. If not able to obtain any tuberculin, use IGRA if available; deferring a TB test because tuberculin is not available is not acceptable if you are able to have an IGRA test completed—cost of the IGRA will not be a valid excuse for failing to properly screen
6. Update your policies and procedures as well as your TB prevention program documents

Remember, all these changes go into effect immediately. Questions may be sent to Sara Gordon (sarah.gordon@state.mn.us or 651-201-5550), the state’s TB controller and program manager.



Doug Beardsley  |  Vice President of Member Services  |   dbeardsl@careproviders.org  |  952-851-2489

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