Division of Substance Abuse Services
Tuberculosis Training Lesson 1

Tuberculosis Control Guidelines for Alcohol and Drug Abuse Treatment Programs

1. Purpose:

This policy provides guidance and instruction to identify and prevent tuberculosis (TB) disease and latent TB infection (LTBI) among employees, volunteers, and service recipients in alcohol and drug (A&D) treatment programs.

2. Policy:

2.1
Testing and medical evaluation to determine the presence or absence of active TB disease or LTBI in employees and volunteers of alcohol and drug treatment programs and recipients of alcohol and drug treatment services must conform to current guidelines of the Tuberculosis Elimination Program of the Tennessee Department of Health.
 
2.2
Alcohol and drug treatment facilities must provide baseline screening of all new employees and new volunteers for symptoms of active TB disease and appropriate testing for LTBI prior to employment or provision of volunteer services.
 
2.3
Alcohol and drug treatment facilities must ensure that all employees and volunteers who provide direct care services are screened annually for symptoms of active TB disease and appropriately tested for LTBI.
 
2.4
Alcohol and drug treatment facilities must counsel all employees and volunteers annually regarding the symptoms and signs of active TB disease.
 
 
2.5
Any alcohol or drug treatment program employee or volunteer with symptoms suggestive of active TB disease must be referred immediately for appropriate medical evaluation and cleared by a licensed medical provider prior to return to work in the facility or provision of direct care services.
 
2.6
Any alcohol or drug treatment program employee or volunteer reported by a health care
provider to the health department as having suspected or confirmed active TB disease must be
excluded from the facility and provision of direct care services until the employee or volunteer is determined to be non-infectious by the State TB Control Officer of the Tennessee Department of Health.
 
2.7
All alcohol and drug treatment facilities must screen all prospective service recipients for symptoms suggestive of active TB disease prior to each admission for alcohol and drug treatment services.
 
2.8
Prospective service recipients presenting with symptoms suggestive of active TB disease must be referred immediately for appropriate medical evaluation and cleared by a licensed medical provider prior to admission for alcohol and drug treatment services.
 
2.9
Any service recipient reported by a health care provider to the health department as having suspected or confirmed active TB disease must be excluded from services until the service recipient is determined to be non-infectious by the State TB Control Officer of the Tennessee Department of Health.
 
 
2.10
Prospective recipients of all alcohol and drug treatment services who present without symptoms of active TB, and have no documentation of a previously positive TB skin test (TST), and have no documentation of testing for LTBI within the past six (6) months must be appropriately tested for LTBI within five (5) business days of initiation of alcohol and drug treatment services. The exception for testing is ASAM Level 1, Outpatient; however, everyone must be screened.
 
2.11
Alcohol and drug treatment facilities must counsel all service recipients about the symptoms and signs of active TB disease during each admission for alcohol and drug treatment services.
 
2.12
All alcohol and drug treatment facilities must provide case management activities to ensure that employees, volunteers, and service recipients diagnosed with LTBI receive appropriate medical evaluation, counseling about the risk of LTBI progressing to active TB disease, and LTBI treatment if such treatment is recommended to and accepted by the employee, volunteer, or service recipient.
 
2.13
Testing for LTBI may be done on-site or by referral to a licensed medical provider.
 
2.14
All TB screening and testing records of employees, volunteers, and service recipients are considered personal medical information protected by HIPAA and must be archived accordingly.

3. Procedure/Responsibility:

General Procedures:

3.1
The Division of Substance Abuse Services must offer training on administration of the “TB Symptom Screening Tool” at least annually.
 
3.2
Only trained alcohol and drug treatment personnel or medical personnel are permitted to administer the “TB Symptom Screening Tool” to program employees, volunteers, or service recipients.
 
3.3
A copy of the completed “TB Symptom Screening Tool” with the results of the screening must be maintained in the file of the employee, volunteer, or service recipient, as applicable.
 
3.4
Testing for LTBI may be conducted using either the standard Mantoux method of the TST or by an interferon-gama release blood assay (IGRA) according to guidelines established by the federal Centers for Disease Control and Prevention (CDC).
 
Specific Procedures: Employees and Volunteers
 
3.5
All new employees and volunteers must be screened with the “TB Symptom Screening Tool” prior to beginning employment or providing volunteer services, and appropriately tested for LTBI within three (3) business days of beginning employment or providing volunteer services.
  1. A new employee or volunteer with symptoms of active TB as documented on the “TB Symptom Screening Tool” should be referred immediately to a licensed medical provider for evaluation, and shall not report to work until written clearance is provided by the licensed medical provider.

  2. A new employee or volunteer without symptoms of active TB and without
    documentation of a previously positive TST should be tested within three (3) business days for latent TB infection (LTBI) utilizing the two-step Mantoux method.


    1. An employee or volunteer with a positive initial TST (consistent with CDC guidelines) should be referred either to his/her medical provider or to the local health department for further evaluation of LTBI, including a chest radiograph.

    2. An employee or volunteer with a negative initial TST should be re- tested within seven to fourteen (7-14) days of the initial test, unless the new employee or volunteer provides documentation of a negative TST within the past twelve (12) months.

    3. An employee or volunteer with a negative second TST should receive education about signs and symptoms of active TB.

    4. An employee or volunteer with a positive second TST should be referred to either his/her medical provider or to the local health department for further evaluation of LTBI, including a chest radiograph.

    5. A single interferon-gama release blood assay (IGRA) may be substituted for the two-step Mantoux TST; any employee or volunteer with a positive IGRA result should be referred to his/her medical provider or to the local health department for further evaluation of LTBI, including a chest radiograph.

  3. A new employee or volunteer without symptoms of active TB and presenting documentation of a previously positive TST result in millimeters (mm) should not be tested with either the TST or an IGRA, but rather referred within five (5) business days of beginning employment or volunteer services to his/her medical provider or to the local health department for further evaluation of LTBI, including a chest radiograph.

  4. All new employees and volunteers should receive education about signs and symptoms of active TB disease within three (3) business days of beginning employment.
3.6
All employees or volunteers providing direct care services must be screened annually for symptoms of active TB disease and appropriately tested with follow-up as described under item 3.5 above, except that TB skin testing of previously TST-negative employees and volunteers should be performed by the one-step Mantoux method.

3.7
Documentation of all TB symptom screening and TB skin testing for LTBI must be treated as personal medical information and archived according to HIPAA guidelines.
 
Specific Procedures: Service Recipients
 
3.8
All recipients of alcohol and drug treatment services must be screened with the “TB Symptom Screening Tool” prior to enrollment in an alcohol and drug treatment program, and be appropriately tested for LTBI within five (5) business days of receiving alcohol and drug treatment services. The exception for testing is ASAM Level 1, Outpatient; however, everyone must be screened.
  1. A prospective recipient of alcohol and drug treatment services with symptoms of active TB as documented on the “TB Symptom Screening Tool” should be referred immediately to a licensed medical provider for evaluation, and shall not be admitted into an alcohol and drug treatment program until written clearance is provided by the medical provider.

  2. A prospective service recipient of alcohol and drug treatment services without symptoms of active TB and without documentation in millimeters (mm) of a previously positive TST, or without documentation of a negative TST within the past twelve (12) months, must be tested within five (5) business days for latent TB infection (LTBI) utilizing the one-step Mantoux method. The exception for testing is ASAM Level 1, Outpatient; however, everyone must be screened.

    1. A service recipient with a positive TST (consistent with CDC criteria)
      should be referred within five (5) business days to a licensed medical
      provider or the local health department for further evaluation of LTBI,
      including a chest radiograph.

    2. A single interferon-gama release blood assay (IGRA) may be
      substituted for the one-step mantoux TST; any service recipient
      with a positive IGRA result should be referred within five (5) business days to a licensed medical provider or to the local health department for further evaluation of LTBI, including a chest radiograph.

  3. A service recipient without symptoms of active TB and presenting documentation in millimeters (mm) of a previously positive TST should not be tested with either the TST or an IGRA, but referred within five (5) business days to a licensed medical provider or to the local health department for further evaluation of LTBI, including a chest radiograph.

  4. All new service recipients of alcohol and drug treatment services must receive education about signs and symptoms of active TB disease within three (3) business days of beginning alcohol and drug treatment services, regardless of receipt of such services within the past year.
3.9
Documentation of all TB symptom screening and TB skin testing for LTBI of service recipients must be treated as personal medical information and archived according to HIPAA guidelines.

4. Statutory Authority:

4.1
States shall require any entity receiving amounts from the Grant, for operating a program of treatment for substance abuse to follow procedures developed by the principal agency of a State for substance abuse, in consultation with the State Medical Director for Substance Abuse Services, and in cooperation with the State Department of Health/Tuberculosis Control Officer, pursuant to 45 C.F.R. 96.127(b). As such, entities not funded by the Grant, to provide treatment services, are not required to adhere to the guidelines contained here in.
 
4.2
Tuberculosis Control Guidelines were developed by the principal agency of a State for substance abuse, in consultation with the State Medical Director for Substance Abuse Services, and in cooperation with the State Department of Health/Tuberculosis Control Officer.

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