Section 696.140  Screening for Tuberculosis Infection and Disease

The TB screening test shall be used when screening persons for infection. (See Appendices A, B, and C of this Part.)  Chest radiographs and bacteriologic examinations can be used when screening certain persons for disease.  (See subsection (b)(2) of this Section.) Persons who have signs and symptoms of disease or positive TB screening test results shall have additional diagnostic tests as recommended in the incorporated publications Treatment of TB and TB Infection and Guidelines for Health-Care Settings.

a)         Screening for TB Infection.  Persons in high-risk groups should be screened for tuberculosis.  Local health department clients who are in high-risk groups should be screened and records maintained of TB screening test results.  These screening requirements can be modified or waived in accordance with Appendix B of this Part.  In addition:

1)         Close Contacts.  Persons who are close contacts to suspected or confirmed cases of TB disease shall be tested with a TB screening test to identify infection.  Close contacts shall be retested three months after the last exposure if their reaction to the first TB screening test was negative.  A high priority should be given to evaluating contacts who are children or contacts infected with HIV/AIDS.

2)         Employees, Volunteers and Clients of High-Risk Congregate Settings and Programs Providing Alcohol and Drug Treatment.  Screening shall be done in accordance with this subsection, Appendices A, B, and C, and the following incorporated publications:  Screening High-Risk Populations; Guidelines for Health-Care Settings; Prevention and Control of Tuberculosis in Correctional Facilities; and the OSHA Instruction.

A)        All employees and volunteers in high-risk congregate settings and programs providing alcohol and drug treatment shall obtain a TB screening test within seven days after being employed.  If Mantoux skin testing is used, two-step testing should be done.  Employees and volunteers who are part of a routine, periodic screening program shall initially be screened by TB screening tests.

B)        All clients in high-risk congregate settings and clients in high-risk groups in programs providing alcohol and drug treatment shall obtain a TB screening test within seven days after admission.  If Mantoux skin testing is used, two-step testing should be done. In addition:

i)          Nursing home residents, persons who inject non-prescribed drugs and other substance users in locally identified high-risk groups (e.g., crack cocaine users) in treatment programs, and clients of programs providing methadone maintenance therapy shall obtain a TB screening test within seven days after admission.  If Mantoux skin testing is used, two-step testing shall be done.

ii)         Routine, periodic screening of the homeless should be done when feasible. (See subsection (b) of this Section.)

iii)         Long-term inmates in detention centers shall obtain a TB screening test within seven days after admission.  If Mantoux skin testing is used, two-step testing should be done when feasible.  Routine, periodic screening of long-term inmates should be done.  Short-term inmates in detention centers should obtain a Mantoux skin test or another TB screening test within seven days after admission, when feasible.  Regardless of TB screening test results, inmates who have HIV infection and those at risk for HIV infection but whose HIV status is unknown should have a chest radiograph as part of the initial screening.  (See subsection (b) of this Section for requirements for screening short-term and long-term inmates for disease.)  Inmates of detention centers shall be screened in accordance with the publications incorporated in this Part.

3)         Employees, Volunteers and Clients of Other Healthcare Settings.  Other healthcare settings should conduct screening programs based upon a risk assessment performed in cooperation with the local TB control authority. Screening programs should be conducted in accordance with the following incorporated publications:  Guidelines for Health-Care Settings and Screening High-Risk Populations.

4)         Employees, Volunteers and Students in a School (Pupil Attendance Center) or School District.

A)        Initial screening of employees and volunteers in a school or a school district shall be performed using a TB screening test within seven days after beginning employment.  This requirement can be modified or waived in accordance with Appendix B of this Part.

B)        When a community, school, or school district has a higher than expected prevalence of TB infection, the local TB control authority or the Department may institute routine, periodic skin testing of school employees, volunteers and students.  Any such testing program should take into consideration:

i)          epidemiologic factors and currently accepted public health standards pertaining to the prevention and control of TB; and

ii)         the identification and availability of necessary school, school district and local TB control authority resources and facilities.

5)         Day Care Center Employees and Volunteers.  Day care center employees and volunteers shall obtain a TB screening test within seven days after being employed.  If Mantoux skin testing is used, two-step testing shall be done.  Routine, periodic screening of employees and volunteers should be determined by a risk assessment performed in cooperation with the local TB control authority.

b)         Screening for TB Disease.

1)         Checklist of Signs and Symptoms.  A checklist that includes but is not limited to pulmonary symptoms (productive prolonged cough, chest pain, hemoptysis) and generalized signs and symptoms (fever, chills, night sweats, easy fatigability, loss of appetite and weight loss) shall be used to screen for TB disease in the following circumstances:

A)        Persons with a documented positive TB screening test result who are required to receive TB screening tests routinely and periodically shall, instead of receiving such screening tests, complete a signs and symptoms checklist. A checklist takes the place of a TB screening test for these persons.  Repeat screening tests are not needed or required.  Routine, periodic chest radiographs should not be done.  Chest radiographs do not take the place of a TB screening test or checklist.

B)        Clients admitted to high-risk congregate settings and programs providing alcohol and drug treatment shall be screened for current disease status with a signs and symptoms checklist in addition to meeting other screening requirements for infection.

2)         Chest Radiography or Bacteriologic Examinations.  The use of chest radiography or bacteriologic examinations should be considered in certain instances in addition to a signs and symptoms checklist.

A)        Chest radiography may be the best screening method in jails, homeless shelters, and single-room-occupancy facilities that house the homeless for more than one night.  Also, inmates who either have HIV infection or are at risk for HIV infection, but whose HIV status is unknown, should receive a chest radiograph as part of the initial screening, regardless of TB screening test results.

B)        Screening for disease among the homeless may also include sputum smears and cultures.

(Source:  Amended at 32 Ill. Reg. 4010, effective February 29, 2008)