Long-Term Care and Retirement Homes: Recommendations for Tuberculosis (TB) Screening
The Long Term Care Homes Act 2007, Ontario Regulation 79/10, and Retirement Homes Act 2010, Ontario Regulation 166/11, require screening for tuberculosis.
The emerging standard of care in Ontario dictates the all new residents must undergo a history and physical examination by a physician/nurse practitioner. This assessment must include:
- A chest x-ray (posterior-anterior and lateral) taken within 90 days prior to admission to the facility. If the chest x-ray indicates potential active pulmonary TB disease, the resident should not be admitted until three sputum samples taken at least one hour apart are submitted to the Public Health Lab for testing (Acid Fast Bacilli and Culture) and the results are negative. Note: It can take up to 8 weeks for a culture report.
- A symptom review for active pulmonary TB disease within 90 days prior to admission or within 14 days after admission. If signs and symptoms indicate potential active pulmonary TB disease see Management of Residents with Suspected Active TB Disease.
- In addition to the above, for residents < 65 years of age who are previously skin test negative or unknown, a 2-step tuberculin skin test (TST) must be done within 90 days of admission or within 14 days after admission. If the TST is positive, treatment of latent TB infection (LTBI) should be considered. A TST is not recommended for residents with a previous positive TST.
Tuberculin skin tests are not recommended to be done upon admission for residents 65 years of age or older. If a TST was previously done, record the date and result of the most recent TST.
In the event that CCAC identifies an individual in crisis requiring immediate admission and a chest x-ray (CXR) cannot be completed, CCAC will complete a symptom review. If the symptom review is positive, the individual must be referred to a physician for follow-up. If the symptom review is negative for active TB, the individual may be considered for admission and the CXR completed within 14 days.
Management of Residents with Suspected Active TB Disease
If at any time, active pulmonary TB disease is suspected in a resident, the individual should be isolated immediately. This involves placing the resident in a single room, keeping the door closed, limiting interactions with staff and visitors and ensuring appropriate personal respiratory protection (i.e. have resident wear a surgical mask, if tolerated while others are in the room; N95 masks are recommended for staff ). Immediate steps should be taken to ensure appropriate medical care, investigation and follow-up according to facility policies and procedures. The Windsor-Essex County Health Unit should be notified and consulted regarding next steps.
Recommendations for Residents admitted to Short Term Care of less than 3 months (e.g. Respite care)
Residents in facilities for short term care should receive an assessment and symptom review by the facility or a physician/nurse practitioner to rule out active pulmonary TB, within 90 days prior to admission or within 14 days after admission. If the symptom review indicates potential active pulmonary TB disease, a chest x-ray must be obtained and active TB disease ruled out. A TST for residents in short term care is not recommended.
Reporting Requirements for Tuberculosis
Under the Health Promotion and Protection Act, R.S.O. 1990, c. H.7, diagnoses of TB infection and cases of suspect and confirmed active TB disease are reportable to Public Health. For information on how to report or to ask for advice related to TB infection or TB disease, please contact the nurses in the TB Program at 519 258-2146 ext. 1777.
Employees and Volunteers
The latest TST must be completed within 2 months before starting work or within 14 days of starting work. If the individual is 65 years of age or older, a CXR and symptom assessment, rather than a TST is recommended.
Requirements for Contract Workers and Students
Supplying agencies or schools are responsible for pre-placement TB assessment and follow-up. This should be clarified with agencies or schools to confirm that individual contract workers and/or students have had their TB skin test and any additional assessment as needed to rule out TB disease prior to starting the placement.
Regular Screening for Employees and Volunteers
Annual TB skin testing is not recommended. Annual chest x-rays are also not recommended in the assessment of positive reactors. If an infectious case of active TB disease occurs in the facility, contact follow-up will be coordinated by the Windsor-Essex County Health Unit. TB skin testing is free for persons identified as a contact of a case of TB disease. Medication for treatment of TB infection and TB disease is free through the Health Unit.