Kentucky Administrative Regulations › Title 902 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR PUBLIC HEALTH › Chapter 20 - Health Services and Facilities › Section 902 KAR 20:200 - Tuberculosis (TB) testing for residents in long-term care settings

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				215.520-215.600,
				216B.010-216B.131,
				216B.990
NECESSITY, FUNCTION, AND CONFORMITY:
				KRS
				216B.042(1) requires the
				Cabinet for Health and Family Services to establish licensure standards and
				procedures to ensure safe, adequate, and efficient health facilities and health
				services. KRS
				215.590 requires a health service or health
				facility licensed pursuant to KRS Chapter 216B or KRS Chapter 333 to report
				knowledge of a person who has active tuberculosis to the local health
				department. This administrative regulation establishes requirements for
				tuberculosis (TB) testing of residents in the following long-term care
				settings: nursing facilities, intermediate care facilities, nursing homes,
				Alzheimer's nursing homes, personal care homes, and intermediate care
				facilities for individuals with an intellectual disability (ICF/IID). These
				procedures are necessary to minimize the transmission of infectious
				tuberculosis among the staff and residents in long-term care settings.
Section 1. Definitions.
(1) "Air changes per hour" or "ACH" means the
			 air change rate expressed as the number of air exchange units per
			 hour.
(2) "Airborne Infection
			 Isolation (AII) room" means a room, formerly called a negative pressure
			 isolation room, which is designed to maintain AII and is a single-occupancy
			 patient-care room used to isolate persons with suspected or confirmed
			 infectious TB disease.
(3) "BAMT
			 conversion" means a change in the BAMT test result, on serial testing, from
			 negative to positive over a two (2) year period.
(4) "Blood Assay for Mycobacterium
			 tuberculosis" or "BAMT" means a diagnostic blood test that:
(a) Assesses for the presence of infection
			 with M. tuberculosis;
(b) Reports
			 results as positive, negative, indeterminate, or borderline; and
(c) Includes interferon-gamma (IFN- £)
			 release assays (IGRA).
(5) "Boosting" or the "booster phenomenon"
			 means if nonspecific or remote sensitivity to tuberculin purified protein
			 derivative (PPD) in the skin test wanes or disappears over time, subsequent
			 tuberculin skin tests (TSTs) may restore the sensitivity.
(6) "Directly observed preventive therapy" or
			 "DOPT" means the DOT for treatment of LTBI.
(7) "Directly observed therapy" or "DOT"
			 means an adherence-enhancing strategy:
(a) In
			 which a health care worker or other trained person watches a patient swallow
			 each dose of medication; and
(b)
			 That is the standard care for all patients with TB disease and is a preferred
			 option for patients treated for latent TB infection (LTBI).
(8) "Extrapulmonary tuberculosis"
			 means TB disease in any part of the body other than the lungs (e.g., kidney,
			 spine, or lymph nodes), and may include the presence of pulmonary TB or other
			 infectious TB diseases.
(9) "Health
			 care workers" or "HCWs" means all paid and unpaid persons working in health
			 care settings who have the potential for exposure to infectious materials,
			 including body substances, contaminated medical supplies and equipment,
			 contaminated environmental surfaces, or contaminated air, and shall include:
(a) Physicians;
(b) Physician assistants;
(c) Nurses;
(d) Medical assistants;
(e) Nursing assistants or nurse
			 aides;
(f) Therapists;
(g) Technicians;
(h) Emergency medical service
			 personnel;
(i) Dental
			 personnel;
(j)
			 Pharmacists;
(k) Laboratory
			 personnel;
(l) Autopsy
			 personnel;
(m) Students and
			 trainees;
(n) Contractual and
			 community-based physicians and other healthcare professionals and staff not
			 employed by the health care facility; and
(o) Persons (e.g., clerical, dietary,
			 housekeeping, laundry, security, maintenance, billing, and volunteers) not
			 directly involved in patient care but potentially exposed to infectious agents
			 that may be transmitted to and from health care workers and patients or
			 residents.
(10)
			 "Induration" means a firm area in the skin that develops as a reaction to
			 injected tuberculin antigen if a person has tuberculosis infection and that is
			 measured in accordance with Section 2(2) of this administrative
			 regulation.
(11) "Infectious
			 tuberculosis" means pulmonary, laryngeal, endobroncheal, or tracheal TB disease
			 or a draining TB skin lesion that has the potential to cause transmission of
			 tuberculosis to other persons.
(12)
			 "Latent TB infection" or "LTBI" means infection with M. tuberculosis without
			 symptoms or signs of disease having been manifested.
(13) "Long-term care setting" means a nursing
			 facility, intermediate care facility, nursing home, Alzheimer's nursing home,
			 personal care home, or intermediate care facility for individuals with an
			 intellectual disability.
(14)
			 "Multidrug-resistant tuberculosis" or "MDR TB" means TB disease caused by M.
			 tuberculosis organisms that are resistant to at least isoniazid (INH) and
			 rifampin.
(15) "Nucleic Acid
			 Amplification" or "NAA" means a laboratory method used to target and amplify a
			 single deoxyribonucleic acid (DNA) or ribonucleic acid (RNA) sequence usually
			 for detecting and identifying a microorganism.
(16) "Polymerase chain reaction" or "PCR"
			 means a system for in vitro amplification of DNA or RNA that can be used for
			 diagnosis of infections.
(17)
			 "Staggered tuberculosis testing" means the testing of a resident in or before
			 the same month as the anniversary date of the resident's admission, or testing
			 in or before the birth month of the resident so that all residents do not have
			 tuberculosis testing in the same month.
(18) "TST conversion" means a change in the
			 result of a test for M. tuberculosis infection in which the condition is
			 interpreted as having progressed from uninfected to infected in accordance with
			 Section 2(4) of this administrative regulation.
(19) "Tuberculin skin test" or "TST" means a
			 diagnostic aid for finding M. tuberculosis infection that:
(a) Is performed by using the intradermal
			 (Mantoux) technique using five (5) tuberculin units of purified protein
			 derivative (PPD); and
(b) Has its
			 results read forty-eight (48) to seventy-two (72) hours after injection and
			 recorded in millimeters of induration.
(20) "Tuberculosis (TB) disease" means a
			 condition caused by infection with a member of the M. tuberculosis complex that
			 meets the descriptions established in Section 2(3) of this administrative
			 regulation.
(21) "Tuberculosis risk
			 assessment" means an initial and ongoing evaluation of the risk for LTBI or
			 active TB disease in a particular resident and is performed in accordance with
			 the provisions established in Sections 3, 7, 8, and 11 of this administrative
			 regulation.
(22) "Two-step TST" or
			 "two-step testing" means a series of two (2) TSTs administered seven (7) to
			 twenty-one (21) days apart and used for the baseline skin testing of persons
			 who will receive serial TSTs, including health care workers and residents of
			 long-term care settings to reduce the likelihood of mistaking a boosted
			 reaction for a new infection.