South Carolina Code of Regulations › Chapter 61 - DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL › Subchapter 61-84 - Standards for Licensing Community Residential Care Facilities › Sec2 61-84.1700 - INFECTION CONTROL AND ENVIRONMENT › Section 61-84.1700.1702 - Tuberculin Skin Testing (I)

Current through Register Vol. 48, No. 6, June 28, 2024
A.
				Tuberculin skin testing is a diagnostic tool for detecting
M.
				tuberculosis
infection. A small dose (0.1 mil) of purified protein
				derivative (PPD) tuberculin is injected just beneath the surface of the skin
				(by the intradermal Mantoux method), and the area is examined for induration
				(hard, dense, raised area at the site of the TST administration) forty-eight to
				seventy-two (48 to 72) hours after the injection (but positive reactions can
				still be measurable up to a week after administering the TST). The size of the
				indurated area is measured with a millimeter ruler and the reading is recorded
				in millimeters, including zero (0) mm to represent no induration.
				Redness/erythema is insignificant and is not measured or recorded. Authorized
				healthcare providers are permitted to perform tuberculin skin testing and
				symptom screening.
B. All
				facilities shall conduct an annual tuberculosis risk assessment (See Section
				101.BBB) in accordance with CDC guidelines (See Section 102.B.16) to determine
				the appropriateness and frequency of tuberculosis screening and other
				tuberculosis related measures to be taken.
C. The risk classification,
i.e
., low risk, medium risk, shall be used as part of the risk
				assessment to determine the need for an ongoing TB screening program for
				staff/direct care volunteers and residents and the frequency of screening. A
				risk classification shall be determined for the entire facility. In certain
				settings,
e.g.
, healthcare organizations that encompass
				multiple sites or types of services, specific areas defined by geography,
				functional units, patient population, job type, or location within the setting
				may have separate risk classifications.
D. Staff/Direct Care Volunteers/Private
				Sitters Tuberculin Skin Testing
1.
				Tuberculosis Status. Prior to date of hire or initial resident contact, the
				tuberculosis status of staff/direct care volunteer/private sitters 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/direct care volunteers/private sitters (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/direct care volunteer or private sitter 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 and read to serve as the baseline prior to
				resident contact.
b. Periodic TST
				or BAMT is not required.
c.
				Post-exposure TST or a BAMT for staff/direct care volunteers 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/suspect. If the TST or the BAMT result is negative,
				administer another TST or a BAMT eight to ten (8 to 10) weeks after that
				exposure to
M. tuberculosis
ended.
d. Post-exposure TST or a BAMT for private
				sitters upon unprotected exposure to
M. tuberculosis
: Written
				evidence of a contact investigation when unprotected exposure is identified
				shall be provided to the facility administrator. The private sitter shall
				provide documentation of a completed single TST or a BAMT prior to resident
				contact. If the TST or BAMT result is negative, the private sitter shall
				provide written evidence of an additional TST or BAMT eight to ten (8 to 10)
				weeks after that exposure to
M. tuberculosis
ended. (CDC:
				Guidelines for Preventing the Transmission of
Mycobacterium
				tuberculosis
in Health-Care Settings, December 30, 2005).
e. Baseline positive with or without
				documentation of treatment for latent TB infection (LTBI) (See Section 101.BB)
				or TB disease shall have a symptoms screen prior to employment and annually
				thereafter.
f. Upon hire,
				staff/direct care volunteers/private sitters with a newly positive test result
				for
M. tuberculosis
infection (
i.e.
, TST or
				BAMT) or signs or symptoms of tuberculosis,
e.g.
, 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). Repeat radiographs are not needed unless
				symptoms or signs of TB disease develop or unless recommended by a physician.
				These staff members/direct care volunteers/private sitters will be evaluated
				for the need for treatment of TB disease or latent TB infection (LTBI) and will
				be encouraged to follow the recommendations made by a physician with TB
				expertise (
i.e.
, the Department's TB Control
				program).
3. Medium
				Risk:
a. Baseline two-step TST or a single
				BAMT: All staff/direct care volunteers/private sitters (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/direct
				care volunteer/private sitter 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 prior to resident
				contact.
b. Periodic testing (with
				TST or BAMT): Annually, of all staff/direct care volunteers who have risk of TB
				exposure and who have previous documented negative results. Instead of
				participating in periodic testing, staff/direct care volunteers with documented
				TB infection (positive TST or BAMT) shall receive a symptom screen annually.
				This screen shall be accomplished by educating the staff/direct care volunteers
				who have documented TB infection about symptoms of TB disease (including the
				staff's and/or direct care volunteers' responses concerning symptoms of TB
				disease), documenting the questioning of the staff/direct care volunteers about
				the presence of symptoms of TB disease, and instructing the staff/direct care
				volunteers 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. Periodic testing
				(with TST or BAMT): Annually, of all private sitters who have risk of TB
				exposure and who have previous documented negative results. Instead of
				participating in periodic testing, private sitters with documented TB infection
				(positive TST or BAMT) shall provide the facility with written evidence of a
				symptom screen annually. Documentation of education about symptoms of TB
				disease (including responses concerning symptoms of TB disease) and written
				evidence of the questioning about the presence of symptoms of TB disease, and
				the report of any such symptoms shall be provided immediately to the facility
				administrator.
d. Post-exposure TST
				or a BAMT for staff/direct care volunteers upon unprotected exposure to
M. tuberculosis
: Perform a contact investigation (See Section
				101.M) when unprotected exposure is identified. Administer one (1) TST or a
				BAMT as soon as possible to all staff/direct care volunteers/private sitters
				who have had unprotected exposure to an infectious TB case/suspect. If the TST
				or the BAMT result is negative, administer another TST or BAMT eight to ten (8
				to 10) weeks after that exposure to
M. tuberculosis
ended.
e. Post exposure
				TST or a BAMT for private sitters upon unprotected exposure to
M
				tuberculosis
: Written evidence of a contact investigation when
				unprotected exposure is identified shall be provided to the facility
				administrator. The private sitter shall provide documentation of a completed
				single TST or a BAMT prior to resident contact. If the TST or BAMT result is
				negative, the private sitter shall provide written evidence of an additional
				TST or BAMT eight to ten (8 to 10) weeks after that exposure to
M.
				tuberculosis
ended.
4. Baseline Positive or Newly Positive Test
				Result:
a. Baseline positive with or without
				documentation of treatment for latent TB infection (LTBI) or TB disease shall
				have a symptoms screen prior to employment and annually thereafter.
b. Upon hire, staff/direct care
				volunteers/private sitters with a newly positive test result for
M.tuberculosis
infection (
i.e.,
TST or BAMT)
				or signs or symptoms of tuberculosis,
e.g.,
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). Repeat chest radiographs are not required unless
				symptoms or signs of TB disease develop or unless recommended by a physician.
				These staff members/direct care volunteers/private sitters will be evaluated
				for the need for treatment of TB disease or latent TB infection (LTBI) and will
				be encouraged to follow the recommendations made by a physician with TB
				expertise (
i.e.,
the Department's TB Control
				program).
c. Staff/direct care
				volunteers/private sitters 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 written approval by the Department's TB
				Control program. Repeat chest radiographs are not required unless symptoms or
				signs of TB disease develop or unless recommended by a physician.