These guidelines briefly describe the overseas medical screening process for refugees resettling to the United States, and outlines the guidelines for clinicians evaluating refugees for tuberculosis (TB) during the domestic medical examination for newly arrived refugees.

• All HCWs should receive baseline TB screening upon hire, using a two-step TST or a single BAMT to test for infection with M. tuberculosis. Should be used for settings in which persons with TB disease are not expected to be encountered.. • After baseline testing for infection with M. tuberculosis, additional TB screening is not necessary unless an exposure to M. tuberculosis occurs. Inpatient Settings with Fewer Than 200 Beds. People in class 1 have been exposed to TB, but their subsequent tuberculin skin test results are negative.The follow-up course of action for people in this category depends on several factors, including how recent and extensive the exposure was and the overall health of the individual. Outpatient, Outreach, and Home-Based Healthcare Settings.

All persons with Class 3 or Class 5 TB should be reported … Links with this icon indicate that you are leaving the CDC website.. • If fewer than six TB patients for the preceding year, classify as low risk. Health care providers should comply with local laws and regulations requiring the reporting of TB. This classification system provides clinicians the opportunity to track the development of TB in their patients. Low risk. • The classification of potential ongoing transmission should be used as a temporary classification only. 1-800-370-9210 If greater than or equal to six TB patients for the preceeding year, classify as medium risk. Sometimes, treatment is started while waiting for the skin test results, particularly in individuals with HIV or young c… This screen should be accomplished by educating the HCW about symptoms of TB disease and instructing the HCW to report any such symptoms immediately to the occupational health unit. The classification of low risk should be applied to settings in which persons with TB disease are not expected to be encountered, and, therefore, exposure to M. tuberculosis is unlikely. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. TB Screening Procedures for Settings (or HCWs) Classified as Potential Ongoing Transmission. Maintaining the classification of medium risk for at least one year is recommended. • If fewer than three TB patients for the proceeding year, classify as low risk. Instead of participating in serial testing, HCWs should receive a symptom screen annually. Please click here to continue without javascript.. JCAHO: Hospitals should track HCW flu vaccines, improve vaccination rates, Flu vaccine rate rises to 96% with mandate, Most HCWs decline treatment for latent TB, Pandemic infection control practices for HCWs, JCAHO Update for Infection Control: Joint Commission considers mandating HCW flu shots, JCAHO Update for Infection Control: JCAHO flu vaccine standard would codify CDC guidance, JCAHO Update for Infection Control: Patient safety alert: Check if transfers on right meds. • HCWs with a baseline positive or newly positive test result for M. tuberculosis infection (i.e., TST or BAMT) or documentation of treatment for LTBI or TB disease should receive one chest radiograph result to exclude TB disease (or an interpretable copy within a reasonable time frame, such as six months). The current clinical classification system for TB used in the United States is based on the pathogenesis of the disease. If uncertainty exists regarding whether to classify a setting as low risk or medium risk, the setting typically should be classified as medium risk. Multidrug-resistant TB (MDR TB) is resistant to more than one anti-TB drug and at least isoniazid (INH) and rifampin (RIF). If greater than or equal to three TB patients for the preceeding year, classify as medium risk. This excerpt from the 2005 TB guidelines explains the new recommendations regarding risk assessment and TB testing: The three TB screening risk classifications are low risk, medium risk, and potential ongoing transmission.

• Testing for infection with M. tuberculosis might need to be performed every eight to 10 weeks until lapses in infection control have been corrected and no additional evidence of ongoing transmission is apparent. It warrants immediate investigation and corrective steps.

• HCWs with a baseline positive or newly positive test result for M. tuberculosis infection or documentation of previous treatment for LTBI or TB disease should receive one chest radiograph result to exclude TB disease. The classification of potential ongoing transmission should be temporarily applied to any setting (or group of HCWs) if evidence suggestive of person-to-person (e.g., patient-to-patient, patient-to-HCW, HCW-to-patient, or HCW-to-HCW) transmission of M. tuberculosis has occurred in the setting during the preceding year.

Inpatient Settings with More Than 200 Beds. Tuberculosis (TB) is an infectious disease that typically affects the lungs, though it can also involve other body parts. The ATS-CDC recommendations are contained, for the most part, in three official joint statements: "Diagnostic Standards and Classification of Tuberculosis," "Treatment of Tuberculosis and Tuberculosis Infection in Adults and Children," and "Control of Tuberculosis." • After baseline testing for infection with M. tuberculosis, HCWs should receive TB screening annually (i.e., symptom screen for all HCWs and testing for infection with M. tuberculosis for HCWs with baseline negative test results). TB Screening Procedures for Settings (or HCWs) Classified as Low Risk. When it affects the lungs, it’s called pulmonary TB. See list of notifiable diseases. The classification of medium risk should be applied to settings in which the risk assessment has determined that HCWs will or possibly will be exposed to people with TB disease or to clinical specimens that might contain M. tuberculosis. You must have JavaScript enabled to enjoy a limited number of articles over the next 360 days.

Need for . After a determination that ongoing transmission has ceased, the setting should be reclassified as medium risk. Evidence of person-to-person transmission of M. tuberculosis includes 1) clusters of TST or BAMT conversions; 2) HCWs with confirmed TB disease; 3) increased rates of TST or BAMT conversions; 4) unrecognized TB disease in patients or HCWs; or 5) recognition of an identical strain of M. tuberculosis in patients or HCWs with TB disease identified by DNA fingerprinting. Treatment for LTBI should be considered in accordance with CDC guidelines. TB Screening Procedures for Settings (or HCWs) Classified as Medium Risk. Significant exposure within the past 3 months warrants a follow-up skin test at about 10 weeks after exposure. • If fewer than three TB patients for the preceding year, classify as low risk. This classification should also be applied to HCWs who will never be exposed to persons with TB disease or to clinical specimens that might contain M. tuberculosis.

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Exposure to M. tuberculosis in these settings is unlikely, and further testing is not needed unless exposure has occurred.. Testing. Risk Classification. If greater than or equal to three TB patients for the preceeding year, classify as medium risk. Health care providers should comply with state and local laws and regulations requiring the reporting of TB disease. CDC TB Screening Risk Classifications This excerpt from the 2005 TB guidelines explains the new recommendations regarding risk assessment and TB testing: The three TB screening risk classifications are low risk, medium risk, and potential ongoing transmission. The current clinical classification system for tuberculosis (TB) is based on the pathogenesis of the disease. Medium risk Repeat radiographs are not needed unless symptoms or signs of TB disease develop or unless recommended by a clinician. Frequency of Testing. All persons with class 3 or class 5 TB should be reported promptly to the local health department.