(a)

1. (1) Upon admission to the nursing home, physician orders shall be obtained to administer a PPD (intermediate strength) tuberculin skin test to the resident and to repeat in ten (10) to fourteen (14) days if necessary.
2. (2) If this initial test reacts positively, the physician should be notified and a chest X-ray obtained and read.
3. (3) The report of this X-ray should be placed on the resident's chart.

(b)

1. (1) If it is not possible to obtain a chest X-ray, a sputum sample should be taken and forwarded for culture.
2. (2) If treatment is indicated, orders are obtained from the attending physician.

(c)

1. (1) If the result of the initial skin test is negative, the skin test should be repeated in ten (10) to fourteen (14) days.
2. (2) If the result of this test is positive, the physician should be notified and a chest X-ray or sputum culture obtained.
3. (3) If treatment is indicated as a result of these tests, orders are obtained from the attending physician.
4. (4) Once a resident has shown a positive skin test, regardless of whether or not further testing indicated treatment, he or she must be re-evaluated yearly.
5. (5) Either a chest X-ray or sputum culture should be obtained.
6. (6) If neither of these is possible, the resident should be evaluated for any visible signs of the disease such as productive cough or weight loss.
7. (7) There should be evidence in the medical record of this yearly re-evaluation.

(b)

1. (1) If, however, the second skin test after admission is also negative, there need be no further testing of this resident unless an active case of tuberculosis is identified in the facility.
2. (2) The medical record of all residents who have shown a positive skin test should be flagged to note that this resident does need to be re-evaluated yearly and that a sputum culture should be obtained following any pulmonary infection.