Long-Term Care and Retirement Home: Recommendations for Tuberculosis (TB) Screening

Residents 

The Fixing Long-Term Care Act, (2021) and the Retirement Home Act (2010), requires that all residents admitted to a long-term care (LTC) home or retirement home (RH) be screened for TB disease ^2,3. This screening should be completed up to 90 days before admission, or within 14 days after admission ^2,3. 

The Canadian Tuberculosis Standards (8^th Edition) was released in March 2022 and provides updated screening recommendations for LTC home residents. These recommendations should also be applied for RH residents as per Tuberculosis Program Guideline, 2023 (Ontario Ministry of Health) ⁴.

Note: The Ministry of Long-Term Care has removed the requirement for a TB chest x-ray for all applicants and requires it only for individuals who have symptoms ⁵.

New resident admissions to LTC and RH homes

• Screen for TB symptoms to rule out TB disease, prior to, and on admission ¹
  • Symptoms include new or worsening cough (lasting three or more weeks); hemoptysis (coughing up blood); non-resolving pneumonia; fever; unexplained weight loss; night sweats; loss of appetite (anorexia); extreme fatigue; lymphadenopathy; chest pain (unexplained), dyspnea (unexplained) ⁵. 
• A posteroanterior and lateral chest x-ray ⁵ should be performed if a resident is symptomatic and the resident should be referred for medical assessment if indicated ¹.
• Asymptomatic residents should be screened for risk factors for TB infection ⁵.
• Routine tuberculin skin testing (TST) on (or prior to) admission is not recommended for residents due to the following factors ¹:
  • High risk of age-related toxicity and potential for drug-drug interactions.
  • Sensitivity to TST and IGRA is reduced in older age.
  • TB disease risk is low and transmission is rare in residents of these facilities who develop TB disease.

Existing Residents in LTC and RH homes 

• Annual or periodic TB skin testing is not recommended for residents ¹.

Note: If a new or existing resident has been exposed to someone with infectious TB, testing should be based on a contact tracing assessment done by Public Health ¹.

Recommendations for Employees and Volunteers

It is recommended that all healthcare workers have a baseline TB screening, including¹:

• A symptom evaluation
• An evaluation of risk factors for TB infection
• A TB skin test for those without documented prior TB disease or latent TB infection
• Staff members with known previous positive TST or past TB disease may be screened for pulmonary TB disease by chest x-ray and symptom/risk screen as required.
• Volunteers should be screened for symptoms and risk factors for active TB disease. With consideration to be given on performing a tb skin test only in those who expect to volunteer at least one-half day/week or who have risk factors for latent tb infection.

Visit TB Screening for Employment for more information or contact the WECHU Infectious Disease Prevention Department at 519-258-2146 ext.1420.