CLINICAL LAB SCIENEC

CHAPTER 6: INTRODUCTION TO INFECTION CONTROL 145
antibody testing, as TB frequently occurs in immunocompromised
persons such as those with HIV infections or those on immunosuppressive
medications. Covered faculty members and students with
a documented history of a positive PPD skin test or adequate treatment
of latent or active disease are not required to obtain further
testing unless signs and symptoms of active TB disease develop.
Often, persons in this category must be routinely screened periodically
to determine if the disease has returned to an active status.
Initial and follow-up tuberculin skin tests should be administered
and interpreted according to current CDC guidelines. A copy of
infection control manuals and/or other manuals and documents
should be available to inform employees of potential risks and
actions to follow when potentially exposed to a pathogen. These
manuals and associated documents are available to all employees
and will include protocol required for further testing or treatment
when a positive PPD occurs.
Infection Control Alert
Workers Most at Risk for Exposure
to Tuberculosis
• Physicians (includes pathologists)
• Nurses
• Physician‘s assistants
• Respiratory therapists
• Radiography technologists
• Laboratory workers (specimen and
patient contact)
• Morgue workers
• EMS personnel (EMTs and
paramedics)
• Corrections personnel
Postexposure Treatment and Follow-up for Tuberculosis • Students in various health care
programs
Immediately after an instructor, student, or worker in an occupational
area covered by guidelines is exposed to a clinically confirmed
case of TB, the following procedures are to be followed.
• Medical course instructors
All workers, instructors, and students who have had close contact
with the infected person will be advised to have a PPD skin test. A negative result
must be obtained before reentering the clinical area. As described previously, the
person must be medically cleared before further participation in the clinical area
or attendance in the classroom. A person who is exposed to TB and who has a
documented history of positive PPD skin tests and radiographic findings must
obtain a current chest radiograph to assess his or her infectious status before
further participation in educational or clinical activities.
Repeat testing of PPD-negative medical workers, faculty members, and
students should be conducted periodically to identify persons whose skin tests
convert to a positive reading. The frequency of repeat testing is risk dependent.
Routinely, the schedule for persons performing high- risk procedures is every
6 months, as required by OSHA. Initial and periodic tuberculin skin tests are
offered to covered faculty members at no cost to the employee . However, students
are responsible for the cost of their skin tests, even after a potential exposure.
Documentation of any exposure incident should be performed within
24 hours of its occurrence if possible. A baseline determination of immune status
as soon as feasible, indicating an earlier exposure or lack thereof, is of the utmost
importance. Exposure to TB is determined to have occurred when any worker is
exposed to a patient or client who exhibits symptoms of active disease or who
tests positive for the disease. There are those who do harbor the organism and
exhibit no symptoms. Some individuals who test positive for TB may have been
exposed years earlier and now have colonies of the organism that are calcified
and walled off in the lungs. This category of person may be a health care worker
or a patient, either of whom may be unaware of the fact that he or she can be a
danger to others.
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