Regulations for TB Control in Minnesota Health Care Settings

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Many health care settings that are state-licensed or are federally-certified in Minnesota have specific state and/or federal TB prevention and control requirements. In addition, all health care settings in Minnesota must follow the requirements of the Minnesota Occupational Safety & Health Administration (MN-OSHA). Occupational safety and health standards are under Minnesota Statute 182.655. (Subdivision 10a details protective equipment, monitoring exposure levels, and medical exams).

Effective June 10, 2019:

• MDH no longer uses a Minnesota-specific algorithm to determine setting TB risk level.
• Settings licensed by MDH will no longer be required to do annual TB screenings of health care personnel to remain in regulatory compliance with MDH, regardless of facility TB risk classification.

This is in accordance with guidance:

• Tuberculosis Screening, Testing, and Treatment of U.S. Health Care Personnel: Recommendations from the National Tuberculosis Controllers Association and CDC, 2019

Much of the new guidance remains unchanged compared with the previous CDC recommendations from 2005.

• Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, CDC, 2005

Important changes and caveats to these changes include the following:

• Discontinue serial (e.g. annual) screening and testing of TB infection after the baseline screening for most health care personnel.
  • Consider continuing serial TB screenings for personnel at increased occupational risk of TB exposure. These groups include, but are not limited to:
    • Pulmonologists or respiratory therapists.
    • Settings in which there is ongoing exposure to Mycobacterium tuberculosis complex, such as TB clinics or laboratories.
    • Settings in which screening requirements are outlined by state statute, such as correctional facilities.
    • Settings where there was evidence of transmission (either in staff, volunteers, residents, or guests) that occurred in the past, such as emergency departments, homeless shelters, home care agencies, nursing homes, and hospices.
  • Post-exposure screening and testing is still required whenever health care personnel have had known exposure to a person with potentially infectious TB disease without the use of adequate personal protection.
• Conduct a new baseline (preplacement) individual TB risk assessment to accompany previously required baseline TB screening test (for those without documented prior TB disease or latent TB infection) and TB symptom assessment.
  • The new risk assessment assists in test interpretation.
• A new emphasis on TB exposure risks (both inside and outside of health care facilities), and symptoms of TB as part of previously required annual TB education for all health care personnel.
  • Personnel who feel they may have had an occupational or nonoccupational exposure to TB following their baseline screening should be encouraged to discuss possible exposures with their primary care provider or occupational health clinician.
• A new strong recommendation to treat all health care personnel with untreated latent TB infection unless medically contraindicated.
  • Shorter treatment regimens, including once-weekly isoniazid and rifapentine for 3 months and daily rifampin for 4 months, should be used as they are more likely to be completed when compared with the traditional regimen of 9 months of isoniazid.
  • CDC: Treatment Regimens for Latent TB Infection (LTBI)
  • CDC: TB Guidelines Testing & Diagnosis

Manual

• Regulations for Tuberculosis Control in Minnesota Health Care Settings, July 2013 (PDF)
  This manual has the following chapters:
  • Background
  • Infection Control Program
  • Screening Health Care Workers
  • Screening Residents
  • Glossary of Terms
• CDC: Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Authorized in the United States
  CDC clinical considerations that include recommendations about COVID-19 vaccination and the timing of immune-based tests for tuberculosis infection, such as the TST and IGRA. Updated August 31, 2021, testing for TB infection with one of the immune-based tests for TB infection can be done before, after, or during the same visit as COVID-19 vaccination.

Resources

Chapter One - Background

• Minnesota OSHA Directive: CPL 2-2.48, Enforcement policy and procedures for occupational exposure to tuberculosis (PDF) is available from the Minnesota Department of Labor and Industry: MNOSHA Compliance: Directives.

Chapter Two - Infection Control Program

• Facility Tuberculosis (TB) Risk Assessment Worksheet and Instructions for Health Care Settings Licensed by the MDH (Word)
  This is the instructional guide and worksheet pair. The worksheet can be used by the following settings: boarding care homes, home care providers, hospices, nursing homes, outpatient surgical centers, and supervised living facilities. Updated 06/2024
• Appendix B. Tuberculosis (TB) risk assessment worksheet (PDF)
  Published by the Centers for Disease Control and Prevention (CDC)
• Additional guidance for determining your setting's TB risk classifications can be found in Appendix C (PDF). Published by the Centers for Disease Control and Prevention (CDC).
• Suggested Components of an Initial TB Training and Education Program for HCWs (PDF)
• Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings, CDC, 2005
  CDC Morbidity and Mortality Weekly Report (MMWR), December 30, 2005 / 54(RR17);1-141.
• Fundamentals of TB Infection Control, CDC (PDF)
  Description of the three-level hierarchy of TB infection control. Pages 6 – 7 of Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005 (CDC).
• Appendix A. Administrative, environmental, and respiratory-protection controls for selected health-care settings, CDC (PDF)
  Appendix A of Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005 (CDC).
• Practical Solutions for TB Infection Control: Infectiousness and Isolation
  60-minute webinar from the Curry International TB Center.

Chapter Three - Screening Health Care Workers

• Baseline TB Screening Tool for Health Care Personnel (Word)
  Adaptable template tool.
• Serial TB Screening Tool for Health Care Personnel (Word)
  Adaptable template tool.
• Exemption Form for Tuberculin Skin Testing of a Pregnant Health Care Worker (Word)
  Adaptable template tool.
• Information for Health Care Workers with Tuberculin Skin Test (TST) Results Between 5 and 9 mm (Word)
  Adaptable template tool.
• The CDC Traveler’s Health - Yellow Book
  TB Chapter.

Chapter Four - Screening Residents

• Baseline TB Screening Tool for Residents of Care Settings (Word)
  Adaptable template tool.
• Baseline TB Screening Tool for Residents in Residential Hospice (Word)
  Adaptable template tool.