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Updated tuberculosis guidelines limit annual testing for health care workers

May 28, 2019

By Mary Beth Versaci

Most health care personnel do not need to undergo annual tuberculosis screenings, according to updated recommendations published May 17 by the National Tuberculosis Controllers Association and Centers for Disease Control and Prevention.

The change comes after data suggested health care workers may no longer be at an increased risk for tuberculosis or latent tuberculosis infection, which is when tuberculosis bacteria are present in the body without evidence of the disease.

Data reported to the CDC from 1995 to 2007 showed tuberculosis rates in the U.S. health care community were similar to those in the general population, “raising questions about the cost-effectiveness of routine serial occupational testing,” the CDC stated.

Tuberculosis rates in the U.S. declined by 73% between 1991 and 2017 and by 42% between 2005 and 2017, according to the CDC.

The CDC’s 2005 tuberculosis screening guidelines for health care personnel recommended baseline screening of all health care workers and annual testing for those working in medium-risk settings or settings with the potential for ongoing transmission.

The updated recommendations include an individual baseline risk assessment, testing of those without prior tuberculosis disease or latent tuberculosis infection, no routine serial testing in the absence of a known exposure or ongoing transmission, treatment and annual symptom screening for personnel with untreated latent tuberculosis infection, and annual tuberculosis education of all personnel.

Dr. Van Scoyoc
Guideline changes: Dr. Stacey K. Van Scoyoc, chair of the ADA Council on Dental Practice, says the updated tuberculosis recommendations are appropriate and welcome.

“This change in the recommendations is appropriate based on this recent data,” said Dr. Stacey K. Van Scoyoc, chair of the ADA Council on Dental Practice. “It’s also welcome news for dental practices across the country since compliance for many will be less onerous and still ensure that health care workers, and the patients they treat, are adequately protected.”

The updates were developed by a CDC and National Tuberculosis Controllers Association work group that was formed in 2015 to discuss possibly revising the 2005 recommendations. The group conducted a systematic review of evidence published after the release of the guidelines, including 36 studies that focused on tuberculosis screening and testing among health care personnel.

The group solicited feedback on the updates from the Advisory Council on the Elimination of Tuberculosis and the Healthcare Infection Control Practices Advisory Committee, as well as attendees of the National Tuberculosis Conference. Commenters supported reducing tuberculosis testing for health care personnel and encouraging treatment of workers with latent tuberculosis infection.

They also backed the work group’s plan for a supplemental document to aid health care facilities in implementing the updated recommendations. The document is expected to be completed this year.

The ADA offers resources on tuberculosis for dental professionals. For more information, visit ADA.org/en/member-center/oral-health-topics/tuberculosis-overview-and-dental-treatment-conside and success.ada.org/en/practice-management/guidelines-for-practice-success/gps-managing-regulatory/11_staff-immunizations-tuberculosis.