R388-804-4. Screening Priorities and Procedures

  (1) Private providers and local health departments shall screen individuals considered to be at high risk for tuberculosis disease and infection before screening is conducted in the general population. Priorities shall be established based on those at greatest risk for disease and in consideration of the resources available.

  (2) Individuals considered at high risk for tuberculosis include the following:

  (a) Close contacts of those with infectious tuberculosis;

  (b) Persons infected with human immunodeficiency virus;

  (c) Individuals who inject illicit drugs;

  (d) Inmates of adult and youth correctional facilities;

  (e) Residents of nursing homes, mental institutions, other long term residential facilities and homeless shelters;

  (f) Recently arrived foreign-born individuals, within five years, from countries that have a high tuberculosis incidence or prevalence;

  (g) Low income or traditionally under-served groups with poor access to health care, e.g., migrant farm workers and homeless persons;

  (h) Individuals who are substance abusers and members of traditionally under-served groups;

  (i) Individuals with certain medical conditions that may predispose them to tuberculosis infection and disease, e.g., diabetes, cancer, silicosis, and immune-suppressive disorders;

  (j) Individuals who have traveled for extended periods of time in countries that have a high tuberculosis incidence or prevalence;

  (k) Other groups may be identified by order of the Department, as needed to protect public health.

  (3) Employers who are required to follow Occupational Safety and Health Administration guidelines for the prevention of tuberculosis transmission disease shall develop and implement an employee screening program.

  (4) Tuberculosis screening shall be completed using either the Mantoux tuberculin skin test method or an FDA approved in-vitro serologic test, e.g. IGRA.

  (a) Screening for tuberculosis with chest radiographs or sputum smears to identify individuals with tuberculosis disease is acceptable in places where the risk of transmission is high and the time required to give the skin test makes the method impractical.

  (b) If the skin test or serologic test yields results indicating tuberculosis exposure, the individual shall be referred for further medical evaluation.