Tuberculosis (TB) Guidelines for Adjustment Training Centers

Purpose:

The purpose of these guidelines is to clarify the need for TB assessment, screening or testing in the South Dakota Adjustment Training Center system.

Rationale:

Effective September 2000, the Department of Health no longer provided PPD (purified protein derivative) universally in the state. The primary reason for this policy change was that the American Thoracic Society/Centers for Disease Control recommended that TB skin testing be targeted to those who are at risk of contracting TB. They also recommended that universal assessment, screening or testing programs be reduced or eliminated. Although there were 20 cases reported in the state in 2003, there have been no cases reported within the adjustment training center system.

Related Administrative Rule:

46:11:06:01 Safety and Sanitation Plan. The ATC must have health, safety, sanitation, disaster plan approved by the division which ensures the health and safety of the consumers. The plan shall include:

1. Specific procedures for responding to medical emergencies
2. Procedures for responding to fire and natural disasters, including evacuation plans, training and regularly scheduled drills
3. Procedures to ensure that equipment is properly installed and maintained and that persons operating the equipment are trained
4. Procedures to ensure that staff and consumers are free from communicable disease
5. Procedures to ensure sanitation of all settings in which services are provided

Recommendations:

All agencies should be aware of the TB risk in the geographical area that they serve. The Department of Health, TB Control Program has developed a TB Risk Assessment Worksheet that can be utilized to determine the risk of TB in a specific geographical area, i.e. county, city, etc. The form, Attachment A, is an algorithm and requires that the agency collect data such as the number of TB cases in the community, i.e. county, city, etc. and the number of individuals being served by the agency that have TB. The number of new TB cases in the community can be determined by accessing this data on the Department of Health web site, http://www.state.sd.us/doh/TB/index.htm. Simply follow the algorithm to determine the TB risk for your agency. This process is recommended to assure optimal health for the individuals receiving services. Generally Adjustment Training Centers have been in the minimal risk or the very low risk categories.

Tuberculin Screening Recommendations for staff and individuals served at the agency.

1. Each new employee and individual served should receive the two-step method of the Mantoux TB skin test to establish a baseline with 2 weeks of employment or admission. If a new employee or individual can document results of a negative Mantoux skin test conducted in the previous 12 months, a single Mantoux skin test may be administered and be considered the second step of the two-step method. Skin testing is not necessary if documentation is provided of a previous positive reaction of 10 mm induration or greater. Any new employee or resident who has a newly recognized positive reaction to the skin test shall have a medical evaluation and a chest x-ray to determine presence or absence of active disease.
2. Any employee or person with a history of a positive Mantoux skin test shall be evaluated annually by their healthcare provider. A record should be maintained to document the presence or absence of symptoms of Mycobacterium Tuberculosis.

Specific Recommendations for Adjustment Training Centers

• Conduct a baseline TB Risk Assessment for the agency. This should be repeated on regular basis to be determined by the agency.
• Assure that all new employees and individuals admitted have a baseline TB skin test. This may either be a single test or a two-step depending on history and documentation of a previous skin test.
• Assure that any new reactors are evaluated by their healthcare provider to determine the presence or absence of active disease.
• Assure that staff or individuals served with a history of a positive reaction have annual evaluations from their healthcare provider to determine the presence or absence of active disease.

Links

SD Department of Health, TB Control Program - www.state.sd.us/doh/TB
DC Division of Tuberculosis Elimination - www.cdc.gov/nchstp/tb
National Prevention Information Network - www.cdcnpin.org
Guidelines for Preventing the Transmission of Mycobacterium Ttuberculosis in Health-Care Facilities, 1994 - http://www.cdc.gov/mmwr/preview/mmwrhtml/00035909.htm

Other References
DD Policy Memorandum 03-09