Ask the expert: TB screening for medical office staff

By: July 9th, 2012 Email This Post Print This Post

Q: What are the OSHA TB screening requirements for medical office staff?

A: OSHA does not set TB screening requirements for healthcare settings, but the CDC does have guidelines that apply to all healthcare settings, including medical offices.

The CDC Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005 identify three risk categories for TB exposure in healthcare settings:

  1. Low risk
  2. Medium risk
  3. Potential ongoing transmission

The low-risk category applies to “settings in which persons with TB disease are not expected to be encountered, and, therefore, exposure to M. tuberculosis is unlikely. This classification should also be applied to HCWs [healthcare workers] who will never be exposed to persons with TB disease or to clinical specimens that might contain M. tuberculosis,” according to the guidelines.

Most medical offices would fall under low-risk category, but not all do, which is why healthcare facilities, including medical practices, should conduct an annual risk TB risk assessment. See the TB Risk Assessment for Ambulatory Settings under the Infection Control heading on the Tools page.

If you qualify as a low risk facility, the CDC says you should follow these procedures for screening staff and volunteers for TB:

  • All HCWs should receive baseline TB screening upon hire, using two-step TST or a single BAMT to test for infection with M. tuberculosis.
  • After baseline testing for infection with M. tuberculosis, additional TB screening is not necessary unless an exposure to M. tuberculosis occurs.
  • HCWs with a baseline positive or newly positive test result for M. tuberculosis infection (i.e., TST or BAMT) or documentation of treatment for LTBI or TB disease should receive one chest radiograph result to exclude TB disease (or an interpretable copy within a reasonable time frame, such as 6 months). Repeat radiographs are not needed unless symptoms or signs of TB disease develop or unless recommended by a clinician.

While the recommendations above are from the CDC, some states however, through the department of health, may have TB prevention regulations that require annual TST testing for all employees in certain healthcare settings.


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By Bruce Cunha on July 10th, 2012 at 9:08 am

Great reminder David.

If more facilities would implement the CDC guidelines and do their assessments, it would significantly reduce the amount of work currently being done on annual TB tests. As you stated, some states have stricter regulations, but there is no good evidence that annual TB testing actually turns up any active TB cases.

The time spent doing TB testing can be better spent educating staff to Think TB and take appropriate respiratory precautions for all patients with respiratory symptoms.

By Jamie McGuire on August 10th, 2018 at 12:18 pm

I am trying to complete our safety program for our medical office and cannot determine if the TB testing is required. We are aware of the requirement to have Hep B testing done but am not sure if the TB testing is required. We are cardiologists and are an ATD exempt facility with regard to having an ATD program. We use screening protocols for ATDs and it appears as though that would cover our TB requirement as well but want to make sure. Thank you for your time.


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