Kentucky Administrative Regulations › Title 902 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR PUBLIC HEALTH › Chapter 20 - Health Services and Facilities › Section 902 KAR 20:205 - Tuberculosis (TB) testing for health care workers

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 health care workers in health facilities or
				settings licensed under KRS Chapter 216B or KRS Chapter 333. These procedures
				are necessary to minimize the transmission of infectious tuberculosis disease
				among staff and patients or residents of health facilities.
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) "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.
(7) "Health care
			 setting" or "health facility" means the following settings:
(a) Abortion facility;
(b) Adult day health program;
(c) Alzheimer's nursing home;
(d) Ambulatory care clinic;
(e) Ambulatory surgical center;
(f) Blood establishment;
(g) Chemical dependency treatment
			 service;
(h) Community mental
			 health center;
(i) Comprehensive
			 physical rehabilitation hospital;
(j) Critical access hospital;
(k) Family care home;
(l) Freestanding birth center;
(m) Group home;
(n) Home health agency;
(o) Hospice program;
(p) Hospital;
(q) Intermediate care facility;
(r) Intermediate care facility for
			 individuals with an intellectual disability (ICF/IID);
(s) Limited services clinic;
(t) Medical laboratory;
(u) Mobile health service;
(v) Network;
(w) Nursing facility;
(x) Nursing home;
(y) Nursing pool;
(z) Outpatient health care center;
(aa) Pain management facility;
(bb) Personal care home;
(cc) Prescribed pediatric extended care
			 facility;
(dd) Psychiatric
			 hospital;
(ee) Primary care
			 center;
(ff) Private duty nursing
			 agency;
(gg) Level I or Level II
			 psychiatric residential treatment facility;
(hh) Rehabilitation agency;
(ii) Renal dialysis facility;
(jj) Residential hospice facility;
(kk) Rural health clinic;
(ll) Special health clinic;
(mm) Specialty intermediate care
			 clinic;
(nn) Specialized medical
			 technology service; or
(oo)
			 Behavioral health services organization.
(8) "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.
(9)
			 "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 3(2) of this administrative
			 regulation.
(10) "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.
(11)
			 "Latent TB infection" or "LTBI" means infection with M. tuberculosis without
			 symptoms or signs of disease having been manifested.
(12) "Multidrug-resistant tuberculosis" or
			 "MDR TB" means TB disease caused by M. tuberculosis organisms that are
			 resistant to at least isoniazid (INH) and rifampin.
(13) "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.
(14)
			 "Polymerase chain reaction" or "PCR" means a system for in vitro amplification
			 of DNA or RNA that can be used for diagnosis of infections.
(15) "Staggered tuberculosis testing" means
			 the testing of a health care worker in or before the same month as the
			 anniversary date of his or her date of initial employment, or testing in or
			 before the worker's birth month so that all health care workers do not have
			 tuberculosis testing in the same month.
(16) "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 3(4) of this administrative regulation.
(17) "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
			 results read forty-eight (48) to seventy-two (72) hours after injection and
			 recorded in millimeters of induration.
(18) "Tuberculosis (TB) disease" means a
			 condition caused by infection with a member of the M. tuberculosis complex that
			 meets the descriptions established in Section 3(3) of this administrative
			 regulation.
(19) "Tuberculosis Risk
			 Assessment" means an initial and ongoing evaluation of the risk for LTBI or
			 active TB disease in a particular health care worker and is performed in
			 accordance with the provisions established in Sections 4, 5, 7, and 11 of this
			 administrative regulation.
(20)
			 "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.