Iowa Administrative Code › Agency 481 - Inspections and Appeals Department › Inspections Division › Chapter 59 - Tuberculosis (TB) Screening › Rule 481-59.2 - Definitions

Current through Register Vol. 47, No. 3, July 24, 2024
For purposes of this chapter, the following definitions
				  apply:
"Bacille Calmette-Guerin vaccination"
or
"BCG vaccination"
means a vaccine for TB. BCG vaccination is
				  used in many countries with a high prevalence of TB to prevent childhood
				  tuberculosis meningitis and miliary disease. BCG vaccination is not generally
				  recommended for use in the United States because of the low risk of infection
				  with
Mycobacterium tuberculosis,
the variable effectiveness of
				  the vaccine against adult pulmonary TB, and the vaccine's potential
				  interference with tuberculin skin test reactivity.
"Baseline TB screening"
means the screening
				  of health care workers (HCWs) of health care facilities or hospitals at the
				  beginning of employment in a facility or hospital and of residents of health
				  care facilities upon admission to a facility for latent tuberculosis infection
				  (LTBI) and TB disease. Baseline TB screening includes a symptom screen for all
				  HCWs and residents, and two-step tuberculin skin test (two-step TST) or single
				  interferon-gamma release assay (IGRA) for M
tuberculosis
for
				  those persons with previous negative test results for M
tuberculosis
infection.
"Baseline TST"
or
"baseline
				  IGRA"
means the two-step TST or IGRA, respectively, which is
				  administered at the beginning of employment to newly hired HCWs or upon
				  admission of residents to health care facilities.
"Boosting"
means a phenomenon in which a
				  person has a negative TST (i.e., false-negative) result years after infection
				  with
M. tuberculosis
and then a positive subsequent TST
				  result. The positive TST result is caused by a boosted immune response of
				  previous sensitivity rather than by a new infection (false-positive TST
				  conversion). Two-step testing reduces the likelihood of mistaking a boosted
				  reaction for a new infection.
"Department"
means the department of
				  inspections and appeals.
"Employment"
or
"employed"
means to be hired or retained for paid or unpaid work in a facility or
				  hospital.
"Extrapulmonary TB"
means TB disease in any
				  part of the body other than the lungs (e.g., kidney, spine, or lymph
				  nodes).
"Health care facility"
or
"facility"
means a health care facility as defined in Iowa
				  Code section
				  135C.1 or a long-term
				  care service of a hospital as defined in rule
				  481-51.38
				  (135B).
"Health care worker"
or
"HCW"
means any paid or unpaid person (including health care
				  students) working in a health care facility or hospital, including any person
				  who is paid either by the health care facility or hospital or paid by any other
				  entity (i.e., temporary agency, private duty, Medicaid/Medicare or independent
				  contractors), or any volunteer who volunteers in a health care facility or
				  hospital on a consistent and regularly scheduled basis for five or more hours
				  per week. Specifically excluded from the definition of "health care worker" are
				  individuals such as visitors, building contractors, repair workers or others
				  who are in the facility or hospital for a very limited purpose and are not in
				  the facility or hospital on a regular basis.
"Hospital"
means a hospital as defined in
				  Iowa Code section
				  135B.1.
"Interferon-gamma release assay"
or
"IGRA"
means a whole-blood test that can aid in diagnosing
M. tuberculosis
infection.
"laryngeal TB"
means a form of TB disease
				  that involves the larynx and may be highly infectious.
"latent TB infection"
or
"ITBI"
means infection with M
tuberculosis
without symptoms or signs of disease having manifested.
"Mantoux method"
means a skin test
				  performed by intradermally injecting 0.1 mL of purified protein derivative
				  (PPD) tuberculin solution into the volar or dorsal surface of the
				  forearm.
"Patient"
means a person admitted to a
				  hospital.
"Pulmonary TB"
means TB disease that occurs
				  in the lung parenchyma, usually producing a cough that lasts greater than three
				  weeks. Pulmonary TB is usually infectious.
"Purified protein derivative tuberculin"
or
"PPD tuberculin"
means a material used in diagnostic tests for
				  detecting infection with
M. tuberculosis.
"Resident"
means a person admitted to a
				  health care facility or a long-term care service of a hospital as defined in
				  rule
				  481-51.38
				  (135B). For purposes of this chapter, "resident" does not include a patient
				  admitted to a hospital.
"Risk classification"
means the category
				  that the infection control team, or designated other staff, determines is
				  appropriate for the facility or hospital as a result of the TB risk
				  assessment.
"Serial TB screening"
means TB screening
				  performed at regular intervals following baseline TB screening. Serial TB
				  screening, also called annual or ongoing TB testing, consists of two
				  components: (1) assessing for current symptoms of active TB disease, and (2)
				  testing for the presence of infection with
M. tuberculosis
by
				  administering either a TST or single IGRA.
"Symptom screen"
means a procedure used
				  during a clinical evaluation in which persons are asked if they have
				  experienced any departure from normal in function, appearance, or sensation
				  related to TB disease (e.g., cough).
"TB patient"
means a person who had
				  undiagnosed infectious pulmonary or laryngeal TB while in a health care
				  facility or hospital during the preceding year. "TB patient" does not include
				  persons with LTBI (treated or untreated), extrapulmonary TB disease, pulmonary
				  TB, or laryngeal TB who have met criteria for noninfectiousness.
"TB risk assessment"
means an initial and
				  ongoing annual evaluation of the risk for transmission of
M.
				  tuberculosis
in a particular health care setting.
"TB screening"
means an administrative
				  control measure in which evaluation for LTBI and TB disease is performed
				  through baseline and serial screening of HCWs in hospitals and health care
				  facilities and residents of health care facilities.
"Transfer"
means an HCW changes employment
				  from one health care facility or hospital to another health care facility or
				  hospital where the time frame between employment does not exceed 90
				  days.
"Treatment for LTBI"
means treatment that
				  prevents the progression of
M. tuberculosis
infection into TB
				  disease.
"Tuberculin skin test"
or
"TST"
means a diagnostic aid for finding
M.
				  tuberculosis
infection. The Mantoux method is the recommended method
				  to be used for TST.
"Tuberculosis"
or
"TB"
means the namesake member organism of
M. tuberculosis
complex
				  and the most common causative infectious agent of TB disease in humans. In
				  certain instances, the species name refers to the entire
M.
				  tuberculosis
complex, which includes
M. bovis, M. african, M.
				  microti, M. canetti, M. caprae,
and
M. pinnipedii.
"Tuberculosis disease"
or
"TB
				  disease"
means a condition caused by infection with a member of the
M. tuberculosis
complex that has progressed to causing
				  clinical (manifesting signs or symptoms) or subclinical (early stage of disease
				  in which signs or symptoms are not present, but other indications of disease
				  activity are present) illness.
"Two-step tuberculin skin test"
or
"two-step TST"
means the procedure used for the baseline skin
				  testing of persons who may receive serial TSTs.