Type Company Name Here

Tuberculosis Program
Approved By: Click here to enter text.

Program Effective Date: Click here to enter text.

Revised 10/19/15
Policy Contents:

 About Tuberculosis……………………………...…………...…………...………… 1
 What is TB and why customers require this testing?
 TB Awareness……………………………………………………………………………. 2
 How TB spreads
 Signs and symptoms of TB
 Self-reporting
 Screening………………………………………………………………………………….. 4
 Testing requirements
 TB screening methods
 Case Management……………………………………………………………………. 6
 What to do with a positive TB case
 Outbreak management
 Contact Tracing/Investigation
 Program Management……………………………………………………………… 10
 Managing your TB information through the NCMS website
 Employee Acknowledgement Form……………………………………..….. 11
 TB Questionnaire Form……………………………………………………………. 12
 About Tuberculosis (TB)
Tuberculosis (TB) is a curable infectious disease caused by the bacteria Mycobacterium
tuberculosis (MTB). MTB usually infects the lungs (Pulmonary TB) but can affect other
parts of the body – brain, skin, kidneys etc. (Extra-pulmonary TB).
More than a third of the world’s population is latently infected with TB. As jobsites
expand into high TB risk zones our employees may be exposed at different working
facilities (e.g. congregate living facilities and offshore drilling rigs). TB is spread by close,
prolonged regular contact between individuals. One active TB case can easily infect
many people in locations where personnel live and work closely together. This could
lead to medical treatments, lost time, work disruption, and possible public concern.

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 TB Awareness
How TB Spreads

TB is spread through the air from one person to another. The TB bacteria are put into the air
when a person with TB disease of the lungs or throat coughs, sneezes, speaks, or sings. People
nearby may breathe in this bacteria and become infected. Since TB is spread only through the
air, here is a list of activities that WILL NOT SPREAD TB:
 shaking someone’s hand
 sharing food or drink
 touching bed linens or toilet seats
 sharing toothbrushes
 kissing

TB Signs and Symptoms

Not everyone infected with TB bacteria becomes sick. As a result, two TB-related conditions
exist: latent TB infection and TB disease.

Latent TB Infection (LTBI)

TB bacteria can live in the body without making you sick. This is called latent TB infection. In
most people who breathe in TB bacteria and become infected, the body is able to fight the
bacteria to stop them from growing. People with latent TB infection do not feel sick and do not
have any symptoms. People with latent TB infection are not infectious and cannot spread TB
bacteria to others. However, if TB bacteria become active in the body and multiply, the person
will go from having latent TB infection to being sick with TB disease.

TB Disease

TB bacteria become active if the immune system can't stop them from growing. When TB
bacteria are active (multiplying in your body), this is called TB disease. People with TB disease
are sick. They may also be able to spread the bacteria to people they spend time with every
day.

Many people who have latent TB infection never develop TB disease. Some people develop TB
disease soon after becoming infected (within weeks) before their immune system can fight the
TB bacteria. Other people may get sick years later when their immune system becomes weak
for another reason.
For people whose immune systems are weak, especially those with HIV infection, the risk of
developing TB disease is much higher than for people with normal immune systems.

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Symptoms of TB disease depend on where in the body the TB bacteria are growing. TB
bacteria usually grow in the lungs (pulmonary TB). TB disease in the lungs may cause
symptoms such as:
 a bad cough that lasts 3 weeks or longer
 chest pain
 coughing up blood or sputum (phlegm from deep inside the lungs)
 weakness or fatigue
 weight loss
 no appetite
 chills
 fever
 sweating at night

Self-Reporting

If you think you have been exposed to someone with TB disease or are experiencing any of the
above symptoms, you should contact your doctor or local health department about getting a TB
skin test or a special TB blood test. If you spent time with the person who has TB disease be
sure to tell the doctor or nurse. You will also need to notify your customers of these
circumstances (i.e. representatives and/or owners).

It is important to know that a person who is exposed to TB bacteria is not able to spread the
bacteria to other people right away. Only persons with active TB disease can spread TB bacteria
to others. Before you would be able to spread TB to others, you would have to breathe in TB
bacteria and become infected. Then the active bacteria would have to multiply in your body
and cause active TB disease. At this point, you could possibly spread TB bacteria to others.
People with TB disease are most likely to spread the bacteria to people they spend time with
every day, such as family members, friends, coworkers, or schoolmates.

***In addition to the above information, here are some available websites that provide
additional information on Tuberculosis symptoms and how TB spreads.

 Center for Disease Control and Prevention http://www.cdc.gov/tb/

 World Health Organization – www.who.int

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 Screening

Each worker falling under TB requirements must:

 Complete a TB Questionnaire and have a cleared TB test before they arrive at customer
TB control program locations. An example TB Questionnaire can be found on the last 2
pages of this document. A Health Clinician will collect the health questionnaires and
review with individuals prior to TB testing.
 Unless exempted by medical, each applicable employee must have a cleared TB test
annually while they remain at customers TB control program locations (a TB
Questionnaire must be completed with each annual test).

There are two kinds of tests that are used to determine if a person has been infected with TB
bacteria:

1. TB blood tests (Preferred method of testing): TB blood tests (also called interferon-gamma
release assays or IGRAs) measure how the immune system reacts to the bacteria that cause
TB. An IGRA measures how strong a person’s immune system reacts to TB bacteria by
testing the person’s blood in a laboratory.

Two IGRAs are approved by the U.S. Food and Drug Administration (FDA) and are available
in the United States:
1. QuantiFERON®–TB Gold In-Tube test (QFT-GIT)
2. T-SPOT® TB test (T-Spot)
o Positive IGRA: This means that the person has been infected with TB bacteria.
Additional tests are needed to determine if the person has latent TB infection or
TB disease (More information on the additional testing can be found under the
following Case Management section).
o Negative (cleared) IGRA: This means that the person’s blood did not react to the
test and that latent TB infection or TB disease is not likely.

IGRAs are the preferred method of TB infection testing for the following:
 People who have received Calmette–Guérin (BCG). BCG is a vaccine for TB disease.
 People who have a difficult time returning for a second appointment to look for a
reaction to the TB Skin Test.

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2. Tuberculin skin test (TST): The TB skin test (also called the Mantoux tuberculin skin test) is
performed by injecting a small amount of fluid (called tuberculin) into the skin in the lower
part of the arm. A person given the tuberculin skin test must return within 48 to 72 hours to
have a trained health care worker look for a reaction on the arm. The health care worker
will look for a raised, hard area or swelling, and if present, measure its size using a
ruler. Redness by itself is not considered part of the reaction.

The skin test result depends on the size of the raised, hard area or swelling. It also depends
on the person’s risk of being infected with TB bacteria and the progression to TB disease if
infected.
 Positive skin test: This means the person’s body was infected with TB
bacteria. Additional tests are needed to determine if the person has latent TB infection
or TB disease. (More information on the additional testing can be found under the
following Case Management section).
 Negative skin test: This means the person’s body did not react to the test, and that
latent TB infection or TB disease is not likely.

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 Case Management
What to Do If You Have a Positive TB result
The steps depend on the signs and symptoms of the positive test.

 Asymptomatic (no signs or symptoms suggestive of TB)

1. Notify your customer representative

2. Conduct a Chest X-Ray (CXR) and refer to approved physician/specialist
3. If confirmed as LTBI – treatment is recommended but follow local law
& regulations
4. Develop a program to effectively monitor affected employee (especially
within the first 2 years)
 Symptomatic: Has signs or symptoms of TB (cough, fever, weight loss, tires easily,
night sweats…)

1. Notify your customer representative

2. Keep off jobsite if applicable, if not, Isolate immediately (procedures
found under Outbreak Management)
3. Keep out of the workplace until clinical clearance of fitness for work is
obtained
4. Further tests are required (CXR, Sputum tests) for individuals actively
producing sputum
5. TB screening tests do not differentiate latent infection from active
disease. TST antigens and IGRAs are approved as aids for diagnosing
tuberculosis infection. Further laboratory tests required to diagnose
Latent TB Infection (LTBI) or active TB disease include:
1. Acid Fast bacilli test (AFB) – Lab microscopy for TB organism, low
yield but useful
2. Sputum Culture – Lab culture for TB organism, results in 4-8 weeks
3. Nucleic Acid Amplification Tests (NAAT) using the GeneXpert TB test -
rapid, sputum test, results in 2hrs + drug sensitivity for Rifampicin
(recommended)

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Outbreak Management
Do not report to work if any of the following symptoms are being experienced:
• Fever in the last 24 hours
• Sore throat
• Chest discomfort
• Aches, pain
• Extreme fatigue
• Diarrhea
• Vomiting
• Upset Stomach

Implement below procedures for any suspected or confirmed case of active TB:

 Notification: Notification of Local Health Authorities and customer personnel of any

active or Latent TB case as required by local laws and regulations.
 Isolation: Isolate affected person by following these steps:
1. Select an isolation room (e.g. bedroom with ensuite bathroom)
2. Direct all personnel to stay out of the isolation room (with exception of care
staff)
3. Use exterior signage to identify the isolation room
4. Require the door to be kept closed at all times
5. Direct visitors to wear a face mask, and to ask the affected person to put on a
mask before visitors enter
6. Direct visitors to remain at least 6 feet (2 meters) from the affected person
7. If the affected person must leave the isolation room, confine movement to the
minimum necessary area, and instruct them to wear a mask and practice
frequent hand-washing
8. Have the affected person consume food and beverages in the isolation room

The following protocols must be followed for individuals who perform the following job tasks
during a TB outbreak

 Transportation: Transport individuals with suspected or confirmed active TB in

accordance with the following procedures:
1. Ensure extra personal protective equipment (PPE) (for example, facemask) is
used by all parties involved (aircrew, other passengers, affected person, and
people assisting the affected person to enter and exit the vehicle).
2. The affected person should maintain a 6 foot distance from all other
personnel at all times (e.g. Leaving the isolation area and during
transportation)
3. Transportation vehicle must be disinfected immediately following transport
with disinfectant solution and all PPE should be disposed of as a biohazard

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 Caterers: Ensure food served to workers is safe while applying the following
measures
1. Personnel Must isolate themselves if they have symptoms such as fever,
cough, chills, sore throat, diarrhea, or vomiting and should not report to
work if they are feeling sick
2. Personnel cleaning and disinfecting should not be involved in the preparation
of food during outbreaks
3. Personnel are required to wash hands and have hand sanitizer positioned in
each galley for use when soap and water are not available
4. Replace shared serving/eating utensils with individually wrapped plastic
silverware utensils
5. Replace communal condiments (salt/pepper, ketchup, mustard, etc.) with
single-serving products
6. Use auto-dispensing ice machines to eliminate hand-dipping for ice
7. Discontinue the use of communal bins for cookies, candies, and snacks
8. Replace communal fabric towel with paper towels to dry hands
9. Handlers must wear gloves to serve food during an outbreak
10. Sanitize pots and pans, maintain water temperature no less than 77°C or
171°F, or as hot as possible.
11. After each food service, cleaning and disinfection of the floors, tables, and
chairs with disposable cleaning cloths and disinfecting solution
 Decontamination: Institute enhanced cleaning and disinfecting measures
1. Immediate disinfection of the affected persons room (surfaces, door knobs,
keyboards, telephones, pen, and materials) is critical to disrupting the
outbreak
2. From the affected person’s room, collect all exposed bedding and fabrics in
large plastic biohazard bags, including roommates’ items
3. Do not fluff the linens and bedding, they may disseminate pathogens into the
environment
4. Launder all collected materials at a minimum 160°F or 71°C for a minimum of
25 minutes
5. Spray bunks/beds and lockers with disinfectant
6. Steam clean carpets, curtains, and other soft furnishings where possible
7. Scrub walls and mop floors. Do not vacuum carpets or buff floors, as this can
potentially recirculate the infective agent
8. In common areas, disinfect at least twice daily all frequently handled surfaces
(door knobs, railings, elevator buttons, exercise equipment, etc.)

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 9. Dispose of all disposable items after use in biohazard bag (PPE, cleaning
towels, etc.)
10. Continue enhanced cleaning and disinfection practices for at least 72 hours
after the last symptomatic case is reported on site.

Contact Tracing/Investigation: Procedure for identifying people who were exposed to

someone with active TB disease (affected person), evaluating them for latent TB infection
(LTBI) and/or active TB disease and providing appropriate treatment as applicable(this must
be performed in accordance with existing local health authority, laws and regulations.
1. Obtain Information from affected person: A minimum of two interviews is
recommended. The first interview should be conducted <1 -3 business days of
reporting. Face to face interview sessions should elicit information about:
Signs and symptoms, Time of onset, Names of contacts, Duration of contact,
Exposure locations especially household, car or other travel mode, or
congregate settings, Current medical issues, Current treatment (including any
TB treatment commenced) etc.
2. Create Specific Contact Investigation Plan: The investigation plan starts with
information gathered in the interviews and site visits; it includes a registry of
the contacts and their assigned priorities; a written timeline which sets
expectations for monitoring the progress of the investigation; and it is part of
the permanent record of the overall investigation for later review and program
evaluation.
3. Classify contacts: Prioritizing contacts is based on the likelihood of infection
and the potential hazards to the individual contact if infected. Take note of the
characteristics of the index patient, susceptibility and vulnerability of contacts,
and circumstances of the exposures to classify contacts as high, medium or
low priority.
4. Investigating of contacts: Medical history and TB (blood or skin) tests.
5. Management of a Negative Contact Screening Test Result: If screening is
negative the individual can: 1) return to work, 2) be followed up in the annual
TB screening program, and 3) be counseled to notify site medical
provider/MOH if they develop signs and/or symptoms suggestive of TB
disease, 4) repeat testing 8–10 weeks after the most recent exposure will help
identify recent test conversions, which are likely indicative of recent infection
6. Management of a Positive Screening Result: If a priority contact has a positive
TB screening test result, further evaluation should be done as soon as possible
to rule out active TB disease.

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 Program Management
The following steps must be taken to maintain a compliant TB Program:

 List all TB required employees names and cleared TB test dates on the NCMS website by
following these steps:
o Go to the NCMS website at www.nationalcompliance.com
o Login with your username and password
o Click the Client Required section then on View/Edit Company Info and Lists
o Scroll down to the TB List section
o Use the add, edit, or delete button to update your list
 Maintain your NCMS Online TB List by ensuring this list is updated at all times (adding
and removing employees when applicable, updating TB testing dates and new testing
has been performed, etc.)
 Ensure each applicable employee is given an annual TB Test and this information is
updated in your online NCMS TB List.
 Ensure each applicable employee signs the TB Program Acknowledgement Form
associated with this TB Program and filed appropriately.

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 TB Program Acknowledgement

I hereby acknowledge that I have been provided a copy of the Click here to enter text.
(Company Name) TB Program. I have read this policy and understand its content.

______________________________
Employee Signature Date

Employee Name (Typed or Printed) Employee ID (4 digit identifier)

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 TUBERCULOSIS QUESTIONNAIRE

1. Have you had a TB skin test in the past?

☐ Yes ☐ No (If “No” continue to question 2)
If “Yes”:
a. List the date of your last skin test: _______________
b. What was the result of this test?
☐Positive ☐ Negative (If “Negative” continue to question 2)
If Positive:
i. How big was the reaction in millimeters? _______________
ii. Was the reaction to the skin test severe (blisters, larger to 20mm, ulcers/sores)?
☐ Yes ☐ No
2. Have you ever been vaccinated against TB with BCG (Bacillus Calmette–Guérin)?
☐ Yes ☐ No (If “No” continue to question 3)
If “Yes” what date was the vaccination? _______________
3. Have you ever been diagnosed or treated for active TB?
☐ Yes ☐ No
4. Have you ever been advised to take medication because of a positive TB skin test?
☐ Yes ☐ No (If “No” continue to question 5)
If “Yes”:
a. Are you still taking the medication?
☐ Yes ☐ No
If “Yes” since what date? _______________
b. Total number of months you took the medication? _______________
5. Do any of the following apply to you?
a. Are you currently undergoing immunosuppressive therapy (chemotherapy, prednisone, anti-
rejection drugs, etc.)?
b. HIV Positive
c. Within the last 24 months lived or worked with a person with active TB
d. Had a chest x-ray showing previous TB infection
☐ Yes ☐ No
6. Do any of the following apply to you?
a. Lived in a country in the past 5 years that has a higher rate of TB
b. Used recreational injection drugs
c. Have any of the following: diabetes, silicosis, leukemia or lymphoma, ear or neck cancer, severe
kidney disease, an organ transplant, unexpected weight list of 10% of your body weight,
gastrectomy or jejunoileal bypass surgery
☐ Yes ☐ No
7. If you have any of the following symptoms, please indicate:
☐ Persistent coughing for more than 2 weeks
☐ Coughing up blood
☐ Night sweats (severe enough to soak bed clothes or sheets)
☐ Significant loss of appetite
☐ Recurrent Fevers
☐ Significant loss of energy/weakness

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 Patient Information Send Results To
Your Name: Company Name:
SS#/ID: Contact Person:
Company Name: Mailing Address:
Date of Completion: Email Address:
Home Country: Fax Number:

Employee Signature: _____________________________________________-

_________________________________________________________________________________________

Clinician Section:

Method of TB Screening used:

☐ Tuberculosis Skin Test (TST)

Manufacturer
Lot Number
Expiration Date
Administration Site
Administration Date
Administered By
To be read on: _______________

☐ Quantiferon Test

Screening Test Results:

TST: mm____ Read on what date: _____________ By: _______________

Result was: ☐ Positive ☐ Negative

Enter Rationale in space below:

QFT: ☐ Positive ☐ Negative ☐ Indeterminate

Disposition: ☐ No action required ☐ 2nd Step TST ☐ Rule out Active TB

Clinician Signature: _________________________________ Date: _______________

Clinic Address: ____________________________________________________________

Phone Number: _______________________________

Clinician please ensure completed form is sent to contact listed above

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