Tuberculin skin testing for high risk patients (methodology to meet most current CDC Guidelines) is
designed to identify patients who are infected with Mycobaclerium tuberculosis before they develop
symptoms (cough, fever, sweats, weight loss) of active disease and become infectious.
For long-term care facilities, screening prior to admission should include PPD testing (following most
recent CDC and VA guidance) and/or chest x-ray as appropriate (routine screening chest x-rays should
only be implemented based on local risk assessment), and include a focused physical examination. In high
or moderate risk areas this should be done prior to admission to the longterm care facility. In minimal or
low risk areas, this screening may be completed within 72 hours of admission if adequate triage is
accomplished.
A. Patient Masks
When any patients are identified as having S/KI TB, they should wear a surgical mask and be placed in
rooms meeting identified engineering controls for S/KI TB patients as noted later in this document.
B. Tuberculin Skin Test (TST) for High Risk Patients
Screening for high risk individuals must be a hospital-wide policy. This includes, but is not limited to, timely
ongoing screening of HIV-positive patients, dialysis patients, the homeless, substance abuse patients and
patients in other high risk special programs such as Hospital Based Home Care (HBHC) and others as
identified by the facility. All these screening programs should use the most current CDC-defined
methodology for TST. If a patient has signs or symptoms suggestive of tuberculosis disease, a full
evaluation must be conducted.
C. Laboratory Assessment
It is critical to expedite the evaluation and treatment of patients with S/KI TB. This includes access
to current laboratory technology for acid fast bacteria (AFB) smears, cultures, and susceptibility
testing.
1. AFB smears, the following is necessary:
a. Available five days per week and reported within 24 hours of specimen receipt
b. Consideration should be given to seven days per week for areas with a high
incidence of TB
c. One sputum per patient per day should be sufficient
2. Cultures for Mycobacterium tuberculosis, the following is needed:
a. Available five days per week
b. Rapid identification methodology
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