Q: What kind of TB precautions should we take for non-employees, such as volunteers, students, contract workers, and contract construction workers who perform services in our hospital? For example, is it necessary to require a TB skin test for all these categories, and would the hospital have to provide it free of charge?
A: Although OSHA guidelines only apply to employer-employee relationships, from an infection control standpoint it comes down to common sense. Anyone who regularly “breathes” in your facility – including students, volunteers – are at the same risk as your own employees and therefore should be managed as such. These healthcare workers should at least have a skin test upon entering service in your facility. That test can be conducted by healthcare facility, or by the contracted service, school, or program.
A few years ago I was called in to assist a long term care facility that had not been testing their volunteers and had decided to add them into their skin testing program. A few of the older volunteers who had worked there for many, many years had a positive skin test and just knew that they were exposed at the hospital. Discussion became so intense that the issue ended up in this small community’s newspaper. If you do the testing up front you avoid this potential issue if an exposure does occur in your facility.
The CDC also offers some guidelines for preventing TB transmission  in healthcare facilities.
For contract services, OSHA says the original employer and the host employer (you in this case) have a dual responsibility. The original employer provides the basic training while the host employer provides site-specific hazard information. For example, if you have construction workers going into possible TB exposure areas the original employer is responsible for training workers on measures to avoid TB infection, including tuberculin skin testing, while you would be responsible for identifying those areas.
Your IC policy should address hazards that students or volunteers could encounter and what specific training or education they should receive. Part of that is based on your facility’s risk assessment for TB, which should be done annually. This risk assessment will also help you determine who should undergo skin testing specifically.
Visit the Tools page  for a sample TB risk assessment for ambulatory settings.