Screening for tuberculosis (TB) in institutional settings usually involves skin testing for tuberculous infection and additional evaluation of those who are infected. In some correctional facilities, it may be more practical to screen with chest x-rays to identify individuals with lung abnormalities suggestive of pulmonary tuberculosis. While the chest x-ray method is more expensive, it can be an acceptable technique to identify and segregate tuberculosis suspects.

1. (1) Tuberculin skin test.

   1. (A) The tuberculin skin test utilizing purified protein derivative (PPD) is the standard method of identifying persons infected with Mycobacterium tuberculosis, the causative agent of TB. The intradermal Mantoux PPD test, not a multiple puncture test, shall be used to detect tuberculous infection.
   2. (B) The Mantoux PPD test is the only type of testing material that is supplied by the Texas Department of Health (department).

2. (2) Administration of tests.

   1. (A) The Mantoux PPD test can be applied by anyone properly trained in tuberculin skin testing procedures including applying, reading, and interpretation.
   2. (B) Unlicensed personnel should be supervised by licensed health care workers according to the requirements of the Board of Medical Examiners and Board of Nurse Examiners in conformity with the Texas Medical Practice Act and the Nurse Practice Act, §218.11, and other applicable laws.

3. (3) Interpretation of tests.

   1. (A) The Mantoux PPD test shall be read 48 to 72 hours after injection. However, if the person is not available for the scheduled reading, positive reactions may still be measurable up to one week after testing. The reading shall be based on measurement of induration (palpable swelling), not erythema (redness). The diameter of induration shall be measured transversely to the long axis of the forearm and recorded in millimeters.
   2. (B) A reaction of 5 mm or greater shall be considered positive in persons who are human immunodeficiency virus (HIV) infected, who are contacts to cases, or who have abnormal chest x-rays consistent with active or inactive tuberculosis. All other persons tested in a corrections facility will be considered positive if their skin test reaction is 10 mm or greater.
   3. (C) Absence of a reaction to the tuberculin test does not exclude the diagnosis of TB or tuberculous infection. Persons who have symptoms consistent with active tuberculosis shall be evaluated for disease even if they have a negative skin test.
   4. (D) The PPD test can be read by anyone properly trained in tuberculin skin testing procedures including applying and reading.
   5. (E) Positive tuberculin reactions in Bacillus Calmette-Guerin (BCG)-vaccinated persons usually indicate infection with TB. Such persons shall be evaluated for preventive therapy. Skin tests should be interpreted without regard to a history of BCG vaccination.

4. (4) Scope. Skin test screening for tuberculosis shall be performed on employees and volunteers as well as inmates of county jails and correctional facilities as follows.

   1. (A) Employees.

      1. (i) Employees who share the same air with inmates shall be screened according to this section unless the employee or volunteer is exempt as described in clauses (ii), (iii), or (iv) of this subparagraph. A certificate or similar document may be used to record results. The recommended certificate is located in §97.179 of this title (relating to the Tuberculosis Record).
      2. (ii) Employees with a history of a positive tuberculin skin test shall provide documentation of the test and any appropriate medical follow-up or a certificate signed by a physician or registered nurse. The documentation shall be included in the certificate or a similar document.
      3. (iii) Employees are exempt from screening if the screening conflicts with the tenets of an organized religion to which they belong.
      4. (iv) Employees may be exempt from screening if medically contraindicated based on an examination signed by a physician. The only valid contraindication is a documented history of severe reaction to a tuberculin skin test.

   2. (B) Volunteers.

      1. (i) All volunteers who share the same air space with inmates on a regular basis (more than 30 hours per month) shall be screened according to this section unless the volunteer is exempt as described in clauses (ii), (iii), or (iv) of this subparagraph. A certificate or similar document may be used to record results. The recommended certificate is located in §97.179 of this title.
      2. (ii) Volunteers with a history of a positive tuberculin skin test shall provide documentation of the test and any appropriate medical follow-up or a certificate signed by a physician or registered nurse. The documentation shall be included in the certificate or a similar document.
      3. (iii) Volunteers are exempt from screening if the screening conflicts with the tenets of an organized religion to which they belong.
      4. (iv) Volunteers may be exempt from screening if medically contraindicated based on an examination signed by a physician. The only valid contraindication is a documented history of severe reaction to a tuberculin skin test.

   3. (C) Inmates.

      1. (i) With the exception of those inmates who meet the criteria in clauses (iii), (iv) or (v) of this subparagraph, all inmates who reside (or are expected to reside) in the facility for seven days or longer shall be screened according to this section. A certificate or similar document may be used to document results. The recommended certificate is located in §97.179 of this title (relating to Tuberculosis Record).
      2. (ii) All inmates must have a screening test if the inmate shows symptoms of tuberculosis or if the inmate has been recently exposed to a diagnosed case of tuberculosis or a tuberculosis suspect and the inmates are not known to be previous positive reactors.
      3. (iii) All inmates must have a screening test unless the inmate has documented results of at least one screening test during the previous 12-month period. Inmates with a history of a positive tuberculin skin test shall provide documentation of the test and any appropriate medical follow-up or a certificate signed by a physician or registered nurse. The documentation shall be included in the certificate or a similar document.
      4. (iv) Inmates are exempt from screening if the screening conflicts with the tenets of an organized religion to which they belong.
      5. (v) Inmates may be exempt from screening if medically contraindicated based on an examination signed by a physician. The only valid contraindication is a documented history of severe reaction to a tuberculin skin test.

5. (5) X-ray screening programs.

   1. (A) Correctional facilities may elect to perform chest x-rays on inmates instead of a skin test screening program.
   2. (B) If inmate chest x-rays screening is done on inmates, the requirement for skin test screening of staff and volunteers will remain in effect.

6. (6) Frequency of screening tests.

   1. (A) Frequency. Annual (or more frequent) tuberculosis (TB) screening of employees, volunteers, or inmates is required. When a specific situation indicates an increased risk of transmission, more frequent TB screening is recommended.
   2. (B) Repeat tests. Employees or volunteers who have a verified record of a previous positive test for TB do not have to have repeat tests.

Source Note:The provisions of this §97.173 adopted to be effective May 16, 1994, 19 TexReg 3370; amended to be effective December 15, 1997, 22 TexReg 12056.