Guidelines on the Prevention and Control of Tuberculosis in Ireland

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<strong>Guidelines</strong> on the Prevention and Control of Tuberculosis in Ireland 2010HSE/HPSCHCWs-Tuberculin Skin TestingRecommendation:HCWs from countries of high TB incidence (≥ 40 cases of TB per 100,000 per year) with apositive TST (Mantoux test) defined as ≥ 10mm (table 2.1) should be referred to a respiratoryor infectious disease clinician (with a chest X-ray) for a medical assessment to rule out TBdisease or LTBI. However, an occupational medicine consultant may wish to treat thesepatients if appropriate protocols, audit of care and resources are in place.Irish HCWs or HCWs from low incidence countries (< 40 cases of TB per 100,000 per year)with a positive TST (Mantoux test) defined as ≥ 15mm (table 2.1) should be referred to arespiratory or infectious disease clinician (with a chest X-ray) for a medical assessment to ruleout TB disease or LTBI. However, an occupational medicine consultant may wish to treat thesepatients if appropriate protocols, audit of care and resources are in place.Treatment for active TB should be considered in HCWs with a positive TST (as outlined above) if the chestX-ray is abnormal, and treatment for LTBI if the chest X-ray is normal and signs and symptoms of diseaseare absent. IGRA testing may be used as a confirmatory test in those individuals with a positive TST.HCWs with active TB should not work while infectious (chapter 6). They will be advised in this regard andwhen to return to work following joint discussion between the treating physician and the occupationalmedicine consultant. The employer will need to consider each case individually taking account ofemployment and health and safety obligations. 329If HCWs with LTBI refuse treatment, the risk of developing TB disease should be explained to themincluding health and safety issues and the oral explanation supplemented by written advice (seeinformation leaflet in appendix 6). In addition, they should be advised to report promptly to theoccupational health department if they become symptomatic. All HCWs should complete an annual healthquestionnaire and be given an annual reminder of the signs and symptoms of TB disease and actionsrequired if they become symptomatic (appendix 6).The following groups should be informed of the signs and symptoms of TB and advised to seek promptmedical attention if they develop these symptoms (see figure 9.1):• Employees from high incidence countries (≥ 40 cases per 100,000 per year) with a TST result ≤10mm• All other employees with a TST result ≤ 15mm.-115-
<strong>Guidelines</strong> on the Prevention and Control of Tuberculosis in Ireland 2010HSE/HPSCFigure 9.1: Algorithm for screening new health care workers (HCWs)Pre-placement questionnaireSymptomatic AsymptomaticRefer for medical evaluationand chest X-rayHigh priority HCW *Intermediate priority HCW **Low priority HCWChest X-ray(if no evidenceof recent ChestX-ray)2TU Mantoux2TU Mantoux15mm - Refer for assessment< 15mm - Inform and advise≤ 5mm and unvaccinated - Consider BCG vaccinationafter risk assessment for HIV infection***2TU Mantoux(Only if no evidence of BCGscar or BCG documentation)AbnormalRefer for medicalevaluationNormal≥10mm - Refer for medical evaluation and consider fortreatment of latent TB infection
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Guidelines on the Prevention and Control of Tuberculosis in Ireland

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