Serial TB testing is protective when a person with a risk for TB and a positive TB test starts and completes treatment to prevent TB disease.  Recently CTCA was asked to provide input on updates needed to the CalOSHA Aerosol Transmittable Disease (ATD) Standard. We prepared the following testimony and continue to make ourselves available to help provide the best protections for healthcare professionals against TB.

Cal/OSHA Standards Board, October 21, 2021, ATD Standards Board Petition 590 Hearing California TB Controllers Association Testimony
Prepared October 05, 2021

The California TB Controllers Association (CTCA) supports a review and update to the Aerosol Transmissible Diseases (ATD) Standard to minimize TB testing of health care personnel (HCP) without an elevated risk for acquiring TB due to the risk in their facility or in their specific job, encouraging use of the best FDA approved test for TB, i.e. IGRAs for those with a history of BCG, encouraging treatment of latent TB infection (LTBI) when identified to prevent TB disease and transmission, and removing outdated CTCA and CDPH guidelines referenced in the ATD Standard.

Background

In 2005, the Centers for Disease Control and Prevention (CDC) published Guidelines for Preventing the Transmission of Mycobacterium Tuberculosis in Healthcare Settings. CTCA did not, at the time, support the recommended changes to TB testing of HCP. CTCA members wanted to review California TB data for HCPs before making any changes to testing practices. In 2016, CTCA members, confident that in general HCPs are not more at risk for acquiring TB than the general public, published the CTCA Position Statement on Annual TB Screening of Health Care Workers, October 17, 2016.  And again, after publication TB Screening, Testing, and Treatment of U.S. Health Care Personnel: Recommendations from the National Tuberculosis Controllers Association and CDC, CTCA reiterated our support of these updates to policies and practice in

the California Tuberculosis Controllers Association response to the release of new recommendations for Tuberculosis Screening, Testing and Treatment of U.S. Health Care Personnel, May 22, 2019.

In general, HCP are protected from TB through baseline testing on hire, contact investigation testing, and taking treatment for latent TB infection (LTBI) when found. Treatment is prevention. Treating LTBI prevents TB disease and TB transmission. CTCA supports TB testing of any HCP when the HCP requests a test for fear of exposure. Again, LTBI treatment is recommended when LTBI is identified in a HCP.

CTCA supports the HCP guidance published this year by the Los Angeles County Department of Public Health (LACDPH) TB Control Program identifying select HCP for serial testing whose regular job duties may place them at higher risk for TB exposure. These duties include performing high hazard procedures (e.g., sputum induction, nebulization, bronchoscopy, endoscopy, autopsy), working in pre-triage patient care areas in urgent care and emergency medicine settings, or working in the mycobacteriology sections of clinical microbiology laboratories.The LACDPH guidance is linked here http://ph.lacounty.gov/tb/docs/HCP_COVID19_interimguidance.pdf. This guidance concurs with the ACOEM GUIDANCE STATEMENT Tuberculosis Screening, Testing, and Treatment ofUS Health Care Personnel ACOEM and NTCA Joint Task Force on Implementation of the 2019 MMWRRecommendations published in July 2020.

CTCA also finds all of the guidelines referred to in the current ATD Standard to be out of date, in need of removal.More general language is recommended, such as see current CTCA CDPH Joint Guidance on the control and prevention of TB in California published on www.ctca.org….

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