Policy Number: 157

Tuberculosis Infection Control

Subject:

Tuberculosis infection control program

Scope:

This policy is applicable to all health care workers who conduct health care related or exposure prone work under the auspices of the university.  In the context of this policy, “health care worker” can refer to employees, residents, students, postdoctoral research fellows, visitors or anyone conducting health care related or exposure prone work under the auspices of the university. This policy also applies to contract workers working in areas identified in the institutional risk assessment as work locations with increased risk for transmission of tuberculosis.

Date Reviewed: September 2013

Responsible Office: Human Resources; Environmental Health & Safety; Applicable Student Affairs Office

Responsible Executive: Vice President and Chief Human Resources Officer; Vice President, Safety, Health and Risk Management; Applicable Dean of Student Affairs

I.     POLICY AND GENERAL STATEMENT

In recognition of tuberculosis as a serious public health threat, The University of Texas Health Science Center at Houston (“university”) adopts the following policy to minimize the risk of exposure of students, faculty, staff, residents, patients and the general public to infectious tuberculosis. These measures are described in detail in the Tuberculosis Control Plan contained in the Institutional Biosafety Manual and are in line with current Centers for Disease Control and Prevention (“CDC”) recommendations. Health care workers are required to become familiar with and to abide by the Tuberculosis Control Plan.

Employees and students with latent tuberculosis may attend classes and perform job duties and educational activities as long as they are physically and mentally able to participate and as long as they are able to perform job duties. Employees and students with infectious tuberculosis may be denied access to the university's facilities, may have restrictions placed on their job duties, and may be placed on a leave of absence until they are no longer infectious.

Without good cause, no health care worker may refuse to treat individuals infected with Mycobacterium tuberculosis or to perform job duties that involve contact with the tuberculosis bacterium. Health care workers must seek prior approval from their supervisors if they have good cause for refusing to treat individuals infected with Mycobacterium tuberculosis or to perform job duties that involve contact with the tuberculosis bacterium.

II.     DEFINITIONS

Tuberculosis: an infectious disease caused by Mycobacterium tuberculosis (“Mtb”) that is transmitted in airborne particles, called droplet nuclei, from a person with infectious tuberculosis and breathed in by a non-infected person who may contract the disease.

Latent tuberculosis: the stage of the disease following initial infection when the immune response limits further multiplication and spread of the disease. A person with latent tuberculosis is not infectious to others as long as the bacterium remains dormant.

Infectious (active) tuberculosis: the stage of the disease after an individual converts to clinically active infectious pulmonary or laryngeal tuberculosis at which time the infected individual can transmit Mtb to others by coughing and sometimes by sneezing or talking.

Health care worker: any paid or unpaid person, including a student, working in a health care facility. The term includes persons not involved directly in patient care (such as non-clinical students, volunteers, housekeepers and clerical staff), but potentially at risk for occupational exposure to infectious tuberculosis.

Employee: any worker who receives a W-2 form, including classified staff, administrative and professional staff, and faculty.

Risk assessment: a procedure to evaluate the level of risk of exposure of individuals to airborne tuberculosis in a work area based on the type of work performed, the prevalence of tuberculosis in the surrounding community and in the particular area of the facility, and the rates of person to person transmission of tuberculosis. Risk of exposure, assessed as low, intermediate, or high, determines the frequency by which health care workers must be retested for tuberculosis. The university's Tuberculosis Control Plan, contained in the Institutional Biosafety Manual, describes the risk assessment procedures.

Exposure to tuberculosis: the possible contact of a non-infected individual with tuberculosis bacilli in airborne droplet nuclei from aerosolized secretions, such as sputum, from persons with infectious pulmonary or laryngeal tuberculosis.

Infectious Diseases Review Committee: A subcommittee of the Biological Safety Committee appointed to review instances of infection from communicable diseases in health care workers and to determine those circumstances, if any, under which a health care worker who is infected with a communicable disease may perform his or her job responsibilities.

III.     PROCEDURE

A. Health Care Workers Tuberculosis Screening Program

Health care workers will be tested upon employment or admission to educational programs and at regular intervals as determined by a licensed healthcare provider under the guidance of the university and based upon a risk assessment in line with current CDC guidelines. The cost of these screenings will be borne by the university.  Contract employees will, at the employer’s expense, comply with tuberculosis screening and surveillance activities.

Detailed screening information is found in the Biological Safety Manual, Tuberculosis Exposure Control Plan.

B. Management of Positive Tuberculosis Skin Tests or Indications of Infection

All positive tuberculosis skin tests will be tracked and monitored by the UT Student Health Clinic (“UTSHC”) for students and UT Health Services (“UTHS”) for employees. Students with a positive tuberculosis skin test will be referred to UTSHC or to the provider of their choice for evaluation and management.

Evaluation and management of employees will be referred to UTHS or to the employees’ respective providers of choice. Employees may use UTHS and will not be responsible for the cost of examination, radiographic studies, laboratory studies and medication.

It is the responsibility of the student or employee to provide documentation of non-infectivity to UTSHC or UTHS.

Health care workers are required to follow CDC guidelines for the prevention of the spread of tuberculosis infection. It is the responsibility of the appropriate supervisor or attending clinician to monitor compliance with all infection control precautions.

The job duties or educational activities of a health care worker with infectious tuberculosis may be restricted in accordance with the Tuberculosis Control Plan found in the Institutional Biosafety Manual. The health care worker has the right to review of any such restrictions and the right to request periodic review by the Infectious Diseases Review Committee. Students should be offered an alternative curriculum if practicable.

Health care workers who fail to comply with tuberculosis testing requirements, treatment for tuberculosis infection, infection control measures, or job restrictions and limitations will be subject to disciplinary action.

C. Confidentiality

Disclosure of an employee’s, student’s, health care worker’s or patient’s tuberculosis status is prohibited except as required or authorized by law.

Tuberculosis status information in worker’s compensation files will not be released without that individual’s written consent. Tuberculosis status information will not be placed in an individual’s personnel or student file.

D. Education Efforts

Health care workers will receive training on measures to prevent exposure to tuberculosis and procedures to manage possible exposures to tuberculosis as described in the Institutional Biosafety Manual.

IV.     CONTACTS

ContactTelephoneEmail/Web Address
Human Resources - Equal Opportunity (questions regarding rights in relation to tuberculosis infection) 713-500-3130 http://www.uth.edu/hr/department/equal-opportunity/index.htm
Environmental Health & Safety (questions regarding the Tuberculosis Control Plan) 713-500-8100 http://www.uth.edu/safety/sherm/ehs-staff.htm
Applicable Student Affairs Office (students with questions regarding their rights in relation to tuberculosis infection)