South Carolina Code of Regulations › Chapter 61 - DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL › Subchapter 61-103 - Residential Treatment Facilities for Children and Adolescents › Sec2 61-103.1700 - INFECTION CONTROL AND ENVIRONMENT › Section 61-103.1700.1702 - Tuberculin Skin Testing (I)

Current through Register Vol. 48, No. 6, June 28, 2024
A. All
				facilities shall conduct an annual tuberculosis risk assessment in accordance
				with CDC guidelines to determine the appropriateness and frequency of
				tuberculosis screening and other tuberculosis related measures to be
				taken.
B. The risk classification,
				such as low risk or medium risk, shall be used as part of the risk assessment
				to determine the need for an ongoing TB screening program for staff and
				residents and the frequency of screening. A risk classification shall be
				determined for the entire facility. In certain settings, such as, healthcare
				organizations that encompass multiple sites or types of services, specific
				areas defined by geography, functional units, resident population, job type, or
				location within the setting, may have separate risk classifications.
C. Staff Tuberculin Skin Testing.
1. Tuberculosis Status. Prior to date of hire
				or initial resident contact, the tuberculosis status of direct care staff shall
				be determined in the following manner in accordance with the applicable risk
				classification:
2. Low Risk:
a. Baseline two-step Tuberculin Skin Test
				(TST) or a single Blood Assay for
Mycobacterium tuberculosis
(BAMT): All staff, within three (3) months prior to contact with
				residents, unless there is a documented TST or a BAMT result during the
				previous twelve (12) months. If a newly employed staff has had a documented
				negative TST or a BAMT result within the previous twelve (12) months, a single
				TST (or the single BAMT) can be administered to serve as the
				baseline.
b. Periodic TST or BAMT
				is not required.
c. Post-exposure
				TST or a BAMT for staff upon unprotected exposure to
M.
				tuberculosis
: Perform a contact investigation when unprotected
				exposure is identified. Administer one (1) TST or a BAMT as soon as possible to
				all staff who have had unprotected exposure to an infectious TB case or
				suspect. If the TST or the BAMT result is negative, administer another TST or a
				BAMT eight to twelve (8 to 12) weeks after that exposure to
M.
				tuberculosis
ended.
3. Medium Risk:
a. Baseline two-step TST or a single BAMT:
				All staff, within three (3) months prior to contact with residents, unless
				there is a documented TST or a BAMT result during the previous twelve (12)
				months. If a newly employed staff has had a documented negative TST or a BAMT
				result within the previous twelve (12) months, a single TST, or the single
				BAMT, can be administered to serve as the baseline.
b. Periodic testing (with TST or BAMT):
				Annually, of all staff who have risk of TB exposure and who have previous
				documented negative results. Instead of participating in periodic testing,
				staff with documented TB infection (positive TST or BAMT) shall receive a
				symptom screen annually. This screen shall be accomplished by educating the
				staff about symptoms of TB disease, including the staff responses, documenting
				the questioning of the staff about the presence of symptoms of TB disease, and
				instructing the staff to report any such symptoms immediately to the
				Administrator. Treatment for latent TB infection (LTBI) shall be considered in
				accordance with CDC and Department guidelines and, if recommended, treatment
				completion shall be encouraged.
c.
				Post-exposure TST or a BAMT for staff upon unprotected exposure to
M.
				tuberculosis
: Perform a contact investigation when unprotected
				exposure is identified. Administer one (1) TST or a BAMT as soon as possible to
				all staff who have had unprotected exposure to an infectious TB case or
				suspect. If the TST or the BAMT result is negative, administer another TST or a
				BAMT eight to twelve (8 to 12) weeks after that exposure to
M.
				tuberculosis
ended.
4. Baseline Positive or Newly Positive Test
				Result:
a. Staff with a baseline positive or
				newly positive test result for
M. tuberculosis
infection, such
				as TST or BAMT, or documentation of treatment for latent TB infection (LTBI) or
				TB disease or signs or symptoms of tuberculosis, such as, cough, weight loss,
				night sweats, fever, shall have a chest radiograph performed immediately to
				exclude TB disease, or evaluate an interpretable copy taken within the previous
				three (3) months. These staff members shall be evaluated for the need for
				treatment of TB disease or latent TB infection (LTBI) and shall be encouraged
				to follow the recommendations made by a physician with TB expertise, such as
				the Department's TB Control program.
b. Staff with positive TST results,
				regardless of when that conversion was first documented, shall document that
				conversion, document a subsequent negative chest radiograph, and receive a
				negative assessment for signs and symptoms of TB before they may be hired or
				admitted, as appropriate.
c. Staff
				who are known or suspected to have TB disease shall be excluded from work,
				required to undergo evaluation by a physician, and permitted to return to work
				only with approval by the Department TB Control program. Repeat chest
				radiographs are not required unless symptoms or signs of TB disease develop or
				unless recommended by a physician.