Medical Center Occupational Health Basics-Appendix 5

Appendix 5

Pdf Summary

This document outlines risk classifications for healthcare settings and the recommended frequency of screening health care personnel (HCP) for Mycobacterium tuberculosis infection, as adapted from 2005 and updated to reflect 2019 CDC/NTCA guidelines. 

Risk is categorized into three levels:

1. <strong>Low Risk:</strong> Applicable in settings such as inpatient facilities handling a small number of tuberculosis (TB) cases annually, or where latent TB infection, rather than TB disease, is the primary concern. Regular serial testing is not mandated in these settings.

2. <strong>Medium Risk:</strong> Applicable in environments where the risk factors don’t meet the low-risk criteria, such as inpatient facilities with a higher volume of TB patients or laboratories handling TB specimens. HCP undergo baseline screening but are not subject to routine serial testing.

3. <strong>Potential Ongoing Transmission:</strong> This classification is used if evidence of ongoing M. tuberculosis transmission is discovered. It requires immediate investigation and corrective actions, with HCP screened repeatedly every 8–10 weeks until the threat subsides. After cessation of transmission, reclassification to medium risk for at least one year is advised.

HCP in all risk categories undergo baseline screening with a two-step tuberculin skin test (TST) or blood assay (IGRA) upon hiring. In the event of unprotected exposure, a contact investigation including one TST or IGRA is initiated immediately and repeated after 8–10 weeks if initial results are negative. Health care settings treating populations at high risk (e.g., those with HIV) may need to adopt a higher risk classification even if they meet low-risk criteria.

This framework helps healthcare settings monitor and mitigate TB infection risks among their personnel effectively, ensuring patient and staff safety.

Keywords

risk classifications

healthcare settings

Mycobacterium tuberculosis

CDC guidelines

latent TB infection

serial testing

baseline screening

tuberculin skin test

blood assay

contact investigation