S.C. Code Regs. § ch. 61, 61-125, 61-125.1700, 61-125.1702

Current through Register Vol. 48, No. 10, October 25, 2024

Subsection 61-125.1702 - Tuberculosis Risk Assessment and Screening. (I)

A. All facilities shall conduct an annual tuberculosis risk assessment (see Section 101.SS) 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, for example, 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 and volunteers and patients and the frequency of screening. A risk classification shall be determined for the entire facility. In certain settings, for example, 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.

C. Staff and Volunteers Tuberculosis Screening.

1. Tuberculosis Status. Prior to date of hire or initial patient contact, the tuberculosis status of staff and volunteers 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 and volunteers (within three (3) months prior to contact with patients) unless there is a documented TST or a BAMT result during the previous twelve (12) months. If a newly employed staff or volunteer 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 patient contact.

b. Periodic TST or BAMT is not required.

c. Post-exposure TST or a BAMT for staff and 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 or 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. Baseline positive with or without documentation of treatment for latent TB infection ("LTBI") (see Section 101.Z) or TB disease shall have a symptoms screen prior to employment and annually thereafter.

e. Upon hire, staff and volunteers with a newly positive test result for M. tuberculosis infection (for example, TST or BAMT) or signs or symptoms of tuberculosis, for example, 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 and volunteers will be evaluated for the need for treatment of TB disease or LTBI and will be encouraged to follow the recommendations made by a physician with TB expertise (for example, the Department's TB Control program).

3. Medium Risk:

a. Baseline two-step TST or a single BAMT: All staff and volunteers (within three (3) months prior to contact with patients) unless there is a documented TST or a BAMT result during the previous twelve (12) months. If a newly employed staff member or volunteer 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 patient contact.

b. Periodic testing (with TST or BAMT): Annually, of all staff and volunteers who have risk of TB exposure and who have previous documented negative results. Instead of participating in periodic testing, staff and volunteers with documented TB infection (positive TST or BAMT) shall receive a symptom screen annually. This screen shall be accomplished by educating the staff or volunteer who have documented TB infection about symptoms of TB disease (including the staff's and/or volunteers' responses concerning symptoms of TB disease), documenting the questioning of the staff or volunteers about the presence of symptoms of TB disease, and instructing the staff or volunteers to report any such symptoms immediately to the administrator. Treatment for 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 or volunteers upon unprotected exposure to M. tuberculosis: Perform a contact investigation (see Section 101.I) when unprotected exposure is identified. Administer one (1) TST or a BAMT as soon as possible to all staff and volunteers 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 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 LTBI or TB disease shall have a symptoms screen prior to employment and annually thereafter.

b. Upon hire, staff and volunteers with a newly positive test result for M.tuberculosis infection (for example, TST or BAMT) or signs or symptoms of tuberculosis, for example, 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 and volunteers will be evaluated for the need for treatment of TB disease or LTBI and will be encouraged to follow the recommendations made by a physician with TB expertise (for example, the Department's TB Control program).

c. Staff and volunteers 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.

D. Patients who are known or suspected to have TB disease shall be transferred from the facility if the facility does not have an Airborne Infection Isolation room, required to undergo evaluation by a physician, and permitted to return to the facility only with written approval by the Department's TB Control program.

E. Individuals who have been declared in writing to be in an emergency crisis stabilization status may be admitted to the facility without the initial step of the two-step tuberculin skin test and/or while awaiting the result of a BAMT. If an individual has any symptoms of active tuberculosis, he or she shall be placed in an area separate from the general population. This admission to the facility may be made provided that:

1. There is documentation at the facility of the declaration by the SCDMH that the admission is, in fact, an emergency (NOTE: Only this agency may declare these crisis stabilization admissions to be an emergency); and

2. The patient will receive the initial step of the two-step tuberculin test within seventy-two (72) hours of admission to the facility. The second step of the two-step tuberculin skin test must be administered within the next seven to fourteen (7 to 14) days; or

3. There is written evidence of a chest x-ray within one (1) month prior to admission and a written assessment by a physician or other authorized healthcare provider that there is no active TB present and a negative assessment for signs and/or symptoms of tuberculosis.

S.C. Code Regs. ch. 61, 61-125, 61-125.1700, 61-125.1702

Added by State Register Volume 43, Issue No. 05, eff. 5/24/2019.