There's a WAC for That!
Tuberculosis (TB) Screening Your Staff
We get questions every day about TB requirements for new hires. Here is a breakdown of what the WAC requires for new hires – whether they have tested positive previously or got a recent test before hire, there are a few steps to consider.
TB tests are required within three (3) days of hire and can be done via skin (intradermal) test or blood test (IGRAs). The two main types of IGRAs are QuantiFERON-TB Gold and T-SPOT.TB.
Even if an employee was tested a week ago or for another job (and it was more than 3 days ago), but their hire date is today, they will still need another TB test.
Resources
Related WAC
WAC 388-76-10265
Tuberculosis—Testing—Required.
(1) The adult family home must develop and implement a system to ensure the following persons have tuberculosis testing within three days of employment:
(a) Provider;
(b) Entity representative;
(c) Resident manager;
(d) Caregiver;
(e) Staff; and
(f) Any student or volunteer providing any resident care and services.
(2) For the purposes of the tuberculosis sections “person” means the people listed in this section as required to have tuberculosis testing.
WAC 388-76-10270
Tuberculosis—Testing method—Required.
The adult family home must ensure that all tuberculosis testing is done through either:
(1) Intradermal (Mantoux) administration with test results read:
(a) Within forty-eight to seventy-two hours of the test; and
(b) By a trained professional; or
(2) A blood test for tuberculosis called interferon-gamma release assay (IGRA).
If an employee tests positive on a skin or blood test, they are required to get a chest x-ray within 7 days of the positive test. Additionally, a signs & symptoms evaluation is required.
WAC 388-76-10290
Tuberculosis—Positive test result.
When there is a positive result to tuberculosis skin or blood testing the adult family home must:
(1) Ensure that the person has a chest X-ray within seven days;
(2) Ensure each resident or employee with a positive test result is evaluated for signs and symptoms of tuberculosis; and
(3) Follow the recommendation of the person’s health care provider.
There are a few circumstances in which someone is not required to have a TB test (i.e. a previous positive test… once you test positive, you will always test positive).
Instead, you must complete a TB signs & symptoms evaluation within the first 3 days of hire. This takes place of the TB test and must be paired with evidence of a previous positive skin or blood test and a negative chest x-ray within 7 days of the positive test or evidence of adequate therapy or completion of treatment.
Coming from a country of origin that immunizes you against TB does not excuse you from the WAC requirements!
WAC 388-76-10275
Tuberculosis—No testing.
The adult family home is not required to have a person tested for tuberculosis if the person has:
(1) A documented history of a previous positive skin test, with ten or more millimeters induration;
(2) A documented history of a previous positive blood test; or
(3) Documented evidence of:
(a) Adequate therapy for active disease; or
(b) Completion of treatment for latent tuberculosis infection preventive therapy.
If the employee has had a negative TB test (skin or blood) within the last 12 months, they only need ONE test upon hire. Ensure they have documentation of the other test as evidence in their file.
WAC 388-76-10280
Tuberculosis—One test.
The adult family home is only required to have a person take one test if the person has any of the following:
(1) A documented history of a negative result from a previous two step test done no more than one to three weeks apart; or
(2) A documented negative result from one skin or blood test in the previous twelve months.
If the employee does not have a previous documented negative test, they will need a repeat the skin test 1-3 weeks after the initial test.
WAC 388-76-10285
Tuberculosis—Two step skin testing.
Unless the person meets the requirement for having no skin testing or only one test, the adult family home, choosing to do skin testing, must ensure that each person has the following two-step skin testing:
(1) An initial skin test within three days of employment; and
(2) A second test done one to three weeks after the first test.
The WAC does not require additional TB tests after hire. It is not an annual requirement. TB testing will only need to be redone if there has been exposure, symptoms presented, or recommended by the healthcare provider.
Please note if you apply for a new license you will need to retest or if a caregiver is a rehire, they will need to retest.
If you own multiple homes, we recommend hiring your caregivers at all of your homes on the same hire date – just in case you need them to “float” or fill in. This will ensure you are in compliance with the 3-day rule.
WAC 388-76-10295
Tuberculosis—Negative test result.
The adult family home may be required by the public health provider or licensing authority to ensure that persons with negative test results have follow-up testing in certain circumstances, such as:
(1) After exposure to active tuberculosis;
(2) When tuberculosis symptoms are present; or
(3) For periodic testing as determined by the health provider.
(Note: New hires need new Name/DOB background check, facility orientations for each home, and TB testing)
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