1
Tuberculosis Screening and
Testing: Residents of Care Facilities (to
include Assisted Living and Nursing Homes)
TB risk assessment: Use of a quesonnaire to determine a person’s risk for TB infecon.
Symptom evaluaon: Assessment for signs and symptoms of acve tuberculosis (TB) disease.
TB tesng: Performing an interferon gamma release assay (IGRA) blood test or tuberculin skin test
(TST) to determine if a person has been infected with M. tuberculosis complex bacteria.
Recommendations and Requirements for Admission
P-02382A (8/2019)
Wisconsin Tuberculosis Program | Wisconsin Department of Health Services
Page 1 of 4
Definitions:
Screening for the presence of communicable disease, including TB, is required upon admission by
Department of Health Services (DHS) WI Admin. Codes for residents of care facilies and includes
the following three steps:
TB risk assessment
Perform a baseline TB risk assessment quesonnaire to determine risk for TB infecon. See resources for an
example quesonnaire
1
.
Symptom evaluaon
Symptoms for TB include cough lasng more than three weeks AND one of more of the following: coughing up
blood, fever, night sweats, unexplained weight loss, or fague.
TB tesng
Perform baseline tesng for all residents without documented evidence of prior LTBI or TB disease. See page 2
for screening of residents with previous posive result. IGRA or TST may be performed; IGRA is preferred.
If tesng is posive, obtain chest x-ray and refer to provider for addional workup for TB disease.
In the absence of newly idened risks or symptoms, previous documented negave IGRA or TST results
(within 12 months) may be used.
If TST is used as the baseline tesng, 2-step tesng is recommended for residents who have not had TST
tesng previously or have only had one negave TST test greater than 12 months ago. If 2 or more TST
tests have been previously performed, all results are negave, and documentaon of results is
available, a one-step TST may be performed before admission.
Inial risk assessment, tesng, and symptom evaluaon can serve as a baseline should an exposure occur and
a TB contact invesgaon become necessary. Addionally, baseline risk assessment, tesng, and symptom
evaluaon can facilitate the detecon and treatment of latent tuberculosis infecon (LTBI) and TB disease to
reduce the risk of transmission within the facility.
2
Residents that have documented posive IGRA or TST results or documented treatment for TB or
LTBI do not need baseline TST or IGRA.
Obtain a baseline chest x-ray and symptom evaluaon. Previous baseline radiographs (within 6
months) may be used for asymptomac residents. Chest x-ray should be repeated if resident is
symptomac.
Serial (annual) follow-up chest x-rays are not recommended.
Treatment for LTBI is recommended to reduce the risk of progression to acve TB disease.
P-02382A (8/2019)
Wisconsin Tuberculosis Program | Wisconsin Department of Health Services
Testing Residents with a History of Positive IGRA or TST
Individuals with a history of TB or LTBI will likely have posive IGRA and
TST results for their lifeme.
Page 2 of 4
Admission Screening
Timing depends on facility type (see
Table 1 on page 4).
Ideally done immediately prior to
admission.
Who May Perform Screening
The type of clinician qualied to
perform the screening depends on
facility type (see Table 1 on page 4).
Timing and Frequency of Screening
Annual (Serial) Tesng for Residents: Most Wisconsin health care
facilies are considered low risk for TB; annual tesng by IGRA or
TST is not recommended.
2
Readmission Screening
If a resident with a negave baseline leaves the facility and is later readmied, perform a
risk assessment quesonnaire and symptom evaluaon.
Only re-test if resident has incurred new risk factors for TB infecon.
3
For those determined to have been
exposed, perform evaluaon for signs and
symptoms of TB disease.
For those who previously had negave
results, administer an IGRA or TST . Do
not perform IGRA or TST for persons with
previous posive results.
Repeat symptom evaluaon and IGRA or
TST at 8–10 weeks aer the end of
exposure if the inial result was negave.
If the symptom evaluaon or the inial or the 8- to 10-week follow-up IGRA or TST is
posive, further evaluate the resident for TB disease, including performing a chest x-ray.
Residents, family, and caregivers should be educated on the signs and symptoms of TB
disease and should seek medical evaluaon if these occur.
P-02382A (8/2019)
Wisconsin Tuberculosis Program | Wisconsin Department of Health Services
Testing After a TB Exposure Event
Type of Facility
Wis. Admin. Code
ch. DHS*
Clinician to
Perform
Timing
Skilled nursing facility
(nursing home)
132 Physician, physician
assistant, or advanced
nurse praconer
90 days prior to admission
Community-based
residenal or respite
facilies (CBRFs)
83 Physician, physician
assistant, advanced
nurse praconer, or
licensed registered nurse
90 days prior to OR within
7 days aer admission
Adult family homes 88 Physician, physician
assistant, or licensed
registered nurse
90 days prior to OR within
7 days aer admission
Facility serving people
with developmental
disabilies
134 Physician, physician
assistant, or advanced
nurse praconer
Not specied; prior to
admission is recommended
Community substance
abuse treatment facilies
75 Not specied Immediately upon
admission and annually
thereaer
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*For more informaon, please visit: hp://docs.legis.wisconsin.gov/code/
Table 1. Summary of WI Administrative Codes
4
P-02382A (8/2019)
Wisconsin Tuberculosis Program | Wisconsin Department of Health Services
Resources
1. Wisconsin Tuberculosis Program TB Risk Assessment Quesonnaire Screen.
www.dhs.wisconsin.gov/forms/f02314.pdf
2. Centers for Disease Control and Prevenon. (2005) Guidelines for prevenng the transmission
of mycobacterium tuberculosis in health-care sengs. MMWR 2005: 54(No. RR-17).
3. Centers for Disease Control and Prevenon (2017). Ocial American Thoracic Society/Infecous
Diseases Society of America/Centers for Disease Control and Prevenon clinical pracce
guidelines: Diagnosis of tuberculosis in adults and children, Clinical Infecous Diseases, 64(2):
111-5. Retrieved from hps://www.cdc.gov/tb/publicaons/guidelines/pdf/ciw778.pdf
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