Public Health Law Map - Beta 5 - Medical and Public Health Law Site

Baseline PPD skin testing and medical history must be obtained on all
employees who are identified as having occupational exposure.
Medical management and follow-up must be provided after exposure
incidents.
Infectious employees must be removed from the workplace until
noninfectious.
There must be acceptable employee training and recordkeeping.
The OSHA regulations require PPD retesting every three to twelve months
depending on the level of risk and exposure history of a given employee. Employees
with a low risk of exposure may be retested yearly. Those with higher risk must be
retested every six months. The latter include those who (1) enter AFB isolation
rooms, (2) perform high- hazard procedures, (3) transport TB patients in an enclosed
vehicle, or (4) work in intake areas in an institution with a high number of TB
patients (6 in 12 months). If there has been a direct exposure, the employee must be
retested immediately and again in three months.
The OSHA regulations do allow for the limitations of the PPD skin test as a
screening test. Anyone who has not had a TB skin test in the last 12 months, must
have a two- step baseline test. This involves doing the test and then repeating it in
two weeks if it is negative or equivocal. This allows them to distinguish true
conversions from the booster effect. A true conversion occurs when the patient
becomes infected with TB between two tests. The booster effect occurs when a
patient has been infected in the past but does not have high levels of antibody. The
first test boosts the antibody levels so that the repeat in two weeks will give a true
reading. Contrary to popular myth, you cannot develop a positive PPD skin test by
having too many tests.
If the employee already has a documented positive PPD skin test, then it does not
have to be repeated. The employer may rely on careful history and chest X ray when
indicated to follow these employees. Routine chest X rays are not required or
recommended. In addition to regular screening of individual employees, regulated
establishments must watch for clusters of disease or skin test conversion. These may
indicate areas where active TB has gone unnoticed or where administrative or
engineering controls have broken down.
When an employee has become infected with TB, whether they have active disease
or silent infection detected on skin testing, the employer must provide medical care
and follow-up. Some states recognize such infection as a compensable injury under
workers’ compensation. Other do not. However, under OSHA regulation, proper care
and treatment must be provided.
An employee who is found to have infectious TB must be put on medical exclusion
from work until they are no longer infectious and do not pose a risk to others. This
means that a medical care professional cannot practice until they are noncontagious.
The nurse who is on medical exclusion from the hospital may not do immunization
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