Tip: Tuberculosis Testing?

With your hectic schedule, it is sometimes easy to overlook simple compliance issues. Advanced Healthcare Studies’ “Tuesday Tips” will bring you a quick, helpful idea each week that can assist you in your operations related to regulatory compliance. We know that many of you implement outstanding practices in your community, and we welcome your ideas as well. If you have a tip that you would like to share, just reply by email and we may share your tip in a future “Tuesday Tip.”

We recently received a question regarding tuberculosis (TB) testing in California assisted living and residential care facilities, so we thought we would review the requirements with you.

Residents

California DSS/CCL regulations (RCFE – 87458, ARF – 80069) require that residents have a TB test as part of the initial medical assessment prior to admission.  Residents with active communicable tuberculosis are of course prohibited from residing in the facility.

Staff

Staff must also be screened for tuberculosis.  RCFE (elderly residents) regulation 87411 requires the screening be completed “not more than six months prior to or seven days after employment.”  General Regulation (adult and group home residents) 80065 requires the testing be completed “not more than one year prior to or seven days after employment or licensure.”  It is also often recommended that Tuberculosis prevention training be added as a topic for continuing education programs at RCFEs.

Cal/OSHA

You should also be aware that Cal/OSHA standards require that increased-risk environments, such as our facilities, perform regular TB testing of employees in accordance with CDC recommendations.  Specifically, the CDC Interim Tuberculosis Control Enforcement Guidelines state: “In general, all employees in increased-risk environments must receive PPD testing at least annually. In the healthcare industry, where exposure potential is particularly high, the required testing frequency can be more frequent, depending upon the degree of risk of transmission of TB in the specific workplace for the category of work being performed.”

This tip was provided by Advanced Healthcare Studies — your source for operational and training products and services.

Sincerely,

Josh Allen, RN
Advanced Healthcare Studies, LLC

37 Responses to “Tip: Tuberculosis Testing?”

  1. Once a healthcare worker has received their two-step PPD do subsequent tests need to be tow-step also?

  2. What options are there for an elderly person who needs dementia care/housing if they have been diagnosed with a positive TB test?

  3. How far in advance of admission to an RCFE can a new resident have a Tb test &/or CXR & still be valid per regs?
    I thought it was 6mos for both, but there is some question on it. Thanks

  4. Hello Terri. According to regulation 87458 the physician report (including TB test) must be made within the last year prior to admission.

  5. How often do caregivers working in a RCFE need to be re-tested for TB?:

  6. If a resident has been resided in your facility for a year and has already gotten a negative TB test, then gets on hospice care… do they need an updated TB test yearly?

    How often do TB test need to be updated in an RCFE?

  7. In ref to TB test for volunteers, if a person is volunteering time to the facility,i.e.comes in to play the piano or other instrument for a short period of time, reads a story, calls Bingo, gives a church service, are they required to submit to a TB test? These volunteers come on a weekly basis but are supervised and have no other interaction with the residents Some are piano students accompanied by a parent. Others give a chair exercise class.

  8. I am new at this administration role but I cannot find anything in Title 22 that says Caregivers/Nurses have to be retested once they are hired. As a nurse, I would say that if someone were exposed to someone with active TB that that would warrant periodic testing for a period.

    TB is a reportable disease to the County Health department (619-515-6770) so I believe the physician there would guide you in treatment of staff member and or patient. Most people who develop active TB need to be hospitalzed for a period of time to be diagnosed and started on the antibiotics. I do not remember how long you must be on the TB drugs but in the “old days” a person needed to have a negative sputum test for AFB (acid fast bacillus)

  9. Aidah… RCFE regulations do not require the resident’s TB test be repeated unless the resident’s physician determines otherwise.

    Bill… no, the volunteer you describe would not require a TB test. Regulation 87411 states: “A signed statement shall be obtained from each volunteer affirming that he/she is in good health.”

    Kathleen… whether or not to repeat TB testing of employees is a tricky one in California. RCFE regulations do not require it, but the California Aerosol Transmissible Diseases (ATD) standard does in some situations. I have heard conflicting reports about whether the ATD regulations apply to an RCFE. CALA recently stated that in their interpretation it does not. You can review the ATD regulations here: http://www.dir.ca.gov/title8/5199.html

  10. Can someone please give me a list of In services that are needed for staff yearly for an RCFE? Thank you so much! hope you all had a wonderful new year.

  11. Aidah… this blog post should help you with that:

    http://blog.careandcompliance.com/continuing-education/tuesday-tip-annual-inservice-training-requirements_12-16-2008/

  12. On admission to an RCFE can a negative TB results from 8 months prior be used? Or would one have to have been given within the last 6 months?

  13. Hello Lori. Per RCFE regulation 87458, the TB test must be included on a physician’s report made within the last year. You can view the regulation here:

    http://www.dss.cahwnet.gov/ord/entres/getinfo/pdf/rcfeman3.pdf

  14. Do residents of an AFC home in Michigan need to have a TB test ?

  15. Thank you Josh for your quick response.

    regarding staff background check clearance, how do we obtain a copy of the clearance ? I checked ccld.ca.gov but it doesn’t show on there because it’s been more than 30 days. Do I have to contact Licensing directly to obtain another copy? or is there another way?

    thanks

  16. Hello Aidah,

    Yes, you would have to check the clearance through your local CCL office. They are listed by facility number.

    Josh

  17. Terry… According to the AFC Group Home Technical Assistance Handbook, an AFC in Michigan must have TB testing for the licensee, Administrator, and direct care staff and it must be repeated every 3 years. You can find more here:

    http://www.michigan.gov/documents/dhs/AFC_Technical_Assistance_Manual_187498_7.pdf

  18. Hello,

    Hope you all had a wonderful Easter, question … If we have Dementia residents, how many hours of Initial training do they need in Dementia? I’ve heard 6 and I’ve heard 8 hours, and once they are Initially trained they need 4 hours each year after that… I’d like to clarify that. Thank you!

  19. If a patient is admitted to an RCFE for respite purposes and the stay is 5 days or less do they still need to be tested for TB?

  20. Hello Kayla… all residents, including those on respite, must have a full physician’s report completed (including TB) prior to admission.

  21. For all who have questions re: staff TB testing, you should also be aware that according to the CDC best practice requires all staff working in any type of health care facility should be tested annually. This is particularly important in any area with a high immigrant population as there are many countries in Central & South America, Asia, and Africa that have a very high rate of TB.

  22. Hello & happy new year!
    I work at a adult residential home in CA & the upcoming CCL audit is on its way. My question is staff required to take TB test every year or every 2 years?

  23. My mom was asked to have a TB test before she moved in to an assisted living place in Irvine CA. She did and it was negative. She now is being required to take another, because is has been 30 days after move in, and then one every year after that. Why? Is the first test not good enough? Then the second should not be either. I volunteer in hospitals and get a yearly test because of my exposure. She and the other residents hardly leave the bldg (she’s in her late 80’s). Is the yearly a requirement, previously someone posts it was not, can someone confirm please?

  24. Hello. It sounds like there may be some confusion at your mom’s community. Residents are not required to have an annual TB test, only prior to admission.

  25. My Mom has a live-in non-medical caregiver hired through an agency. Is the caregiver required to have a TB test?

  26. Hello Paula. Non-medical in home care is not current regulated in California, and therefore a TB test is not required. However, many of the more professionally managed home care agencies choose to require health screenings, including TB testing, of their staff.

  27. When does a volunteer need to be fingerprinted and when do they need to have a TB test administered? Thanks for your help!!

  28. How often are employees that work in a RCFE have to take a TB test and be in compliance with OSHA

  29. Hello Lorie… That is answered in my previous comments:

    …whether or not to repeat TB testing of employees is a tricky one in California. RCFE regulations do not require it, but the California Aerosol Transmissible Diseases (ATD) standard does in some situations. I have heard conflicting reports about whether the ATD regulations apply to an RCFE. CALA recently stated that in their interpretation it does not. You can review the ATD regulations here: http://www.dir.ca.gov/title8/5199.html

  30. If a caregiver leaves the country and returns to start work is their a requirement to retest prior to working with patients? Leaving the country creates worry. California private home care and a retirement continued care facility.

  31. Hello Ann. There isn’t anything in the RCFE regulations that specifically requires that.

  32. Please, let me know about regulations who can do PPD test for adult day care patients. Can it be done by RN with or without supervision of MD? Do RNs have to have a special certificate/classes?

  33. Hi
    Is it CA regulation/law that requires residents of a licensed Board and Care facility for the elderly to be tested for TB? My mom has lived there for 7 years and the owner said we needed to get her a TB test, but insurance and Medicare won’t pay for it. Is it required every year?
    thanks

  34. Hello, how often does a CNA or non-medical caregiver needs to be tested for TB in the Houston area?

  35. Josh,

    Thanks for the help. I was trying to see if the TB portion of the 602A needed to be filled out for an annual renewal of the 602A for a current resident with dementia. It seems the regs do not require re-testing for TB for current residents, thank again!

  36. How often do caregivers working in a RCFE need to be re-tested for TB?

  37. Hey Viorel, Although Title 22 regs. only require health screening and testing for TB at time-of-hire, there are some Health Department and OSHA regulations that require employees in high-risk environments to have annual TB tests. So although you may not need to have employees screened/tested for TB to maintain compliance with RCFE rules/regulations/codes, you may still need to have employees tested annually to meet Health Department or OSHA regulations.

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