February 11, 2009

Ground hog day comes to Minnesota


Important Bulletins on TB Screening for Health Care Providers Released


February 9, 2009

The Minnesota Department of Health has taken an important step to bring Tuberculosis screening requirements for various types of licensed health care providers up-to-date and into conformity with current guidelines from the Centers for Disease Control.

MDH has issued four separate information bulletins--for nursing homes, boarding care homes, home care and supervised living facilities--that grant "blanket" waivers to the specific TB screening requirements in rule for all of these providers.

This action was the result of work the MDH Compliance Monitoring Division initiated with the MDH TB Prevention and Control Program staff and OSHA staff to develop a more consistent approach to TB screening based on the most current evidence-based research from CDC. Aging Services of Minnesota and other provider groups have been urging MDH for several years to update the TB requirements, particularly as physicians have voiced more and more reluctance to order multiple x-rays for staff with positive Mantoux. Aging Services appreciates the efforts of MDH staff to resolve this long-standing issue.

The new MDH bulletins link to a detailed list of waiver conditions that has been developed for each type of licensed provider. As long as the provider follows the applicable waiver conditions, the provider does not need to submit to MDH an individual request to waive the obsolete TB screening requirements in the applicable licensing rules.

The waiver provisions will remain in effect indefinitely, although MDH staff has told Aging Services that MDH might be interested in working with provider groups sometime in the future to make statutory changes to permanently delete the obsolete rules.

The waiver conditions for all types of providers require that all paid and unpaid health care workers (HCW, as defined in the CDC Guidelines) must receive baseline TB screening. This screening must include a written assessment of the HCW's risk factors for TB and any current TB symptoms, and a two-step tuberculin skin test (TST) or single interferon gamma release assay (IGRA) for M.tuberculosis (e.g., QuantiFERONR TB Gold or TB Gold- InTube, T-SPOTR.TB). This may be a change for many home care agencies, as the home care rules do not require a two-step Mantoux.

Having an alternative screening method to the Mantoux will be helpful for workers who know they would have a positive Mantoux.

The bulletins and the waiver conditions are found at the following links:

Aging Services will be evaluating the need for additional member training related to the waiver conditions.

Providers may purchase the 143-page 2005 CDC TB Guidelines in a handy binder format from Aging Services of Minnesota for $50.(Item number REG5025; go to www.agingservicesmn.org and click on "store" or call Alecia Crumpler at 651-645-4545 or 800-462-5368.)

For Further Information:
Contact Mary Youle at myoule@agingservicesmn.org, Darrell Shreve at dshreve@agingservicesmn.org or Liz Sether at lsether@agingservicesmn.org.