Recommendation for Tuberculosis (TB) Screening in Long-Term Care Homes
Recommendations for Residents ≥65 years of age:
As per the Long-Term Care Homes Act: All new residents must be screened for tuberculosis within 14 days of admission unless the resident has already been screened in the 90 days prior to admission and the documented results of this screen are available to the LTCH. Screening includes:
- A chest x-ray (posterior-anterior and lateral), a health assessment and symptom review done within 90 days prior to or within 14 days of admission to the facility.
In the absence of an available chest x-ray:
- Clients who cannot undergo chest x-ray should have a health assessment and symptom review for active TB disease. Note: this should ONLY be considered for clients with extreme physical challenges, including those whose physical disabilities cause significant transportation issues. Health assessment should include reviewing any chest x-rays done in past year.
If signs and symptoms and/or chest x-ray indicate potential active TB disease, the resident should not be admitted until three sputum samples taken at least 8 hours apart are submitted to Public Health Lab for testing (Acid Fast Bacilli and Culture) and the results are negative.
Residents <65 years of age:
For residents who are previously skin test negative or unknown, a 2-step tuberculin skin test is recommended. If TST is positive, treatment for latent TB infection (LTBI) should be considered. TST is NOT recommended for residents with previous positive TST.
Recommendations for Short-Term Care or palliative admissions (stay of less than 3 months, i.e. respite care):
Residents should receive an assessment and symptom review by a physician or Nurse Practitioner to rule out active pulmonary TB, within 90 days prior to or within 14 days after admission. If symptoms indicate potential pulmonary TB, a chest x-ray must be obtained and active TB disease ruled out. TST for short-term care residents is not recommended.
Recommendations for LTCH resident transfers:
Prior to transfer from another facility, a physical assessment and symptom review by a physician or Nurse Practitioner to rule out active pulmonary TB is recommended. In addition, a review of the documented TB screening previously done upon admission or a review of more recent radiology should be done. If there is any indication of possible active TB, a chest x-ray, sputum testing and any other necessary investigations should be completed to rule out active pulmonary TB disease before the transfer occurs.
Reporting requirements for Tuberculosis:
Under the Health Promotion and Protection Act, R.S.O. 1990, c. H.7, diagnoses of TB infection (LTBI) and cases of suspect and confirmed active TB disease are reportable to Public Health. To report a case of TB infection or disease, please call the Eastern Ontario Health Unit at 613-933-1375 or 1 800 267-7120 and ask to speak to the Infectious Diseases Team.