On August 13, 2021, the Indiana Department of Health (IDH) issued advisory letters on Tuberculosis (TB) assessment and testing of residents in comprehensive care facilities (nursing facilities) and residential care facilities (licensed assisted living). The advisory letter for nursing facilities can be found here, and the advisory letter for licensed assisted living can be found here.
Indiana’s regulations typically require residents to have received a chest x-ray no more than six (6) months prior admission, and a TB skin test within three (3) months prior to admission, or upon admission and read at 48 to 72 hours. These requirements have been waived as a result of the public health emergency, but going forward, to be exempt from the applicable regulations regarding chest x-rays and TB testing, facilities must formally adopt and implement policies as described in IDH’s “Tuberculosis Assessment and Testing of Long-Term Care Residents,” which be found here. If a facility is not adhering to the applicable regulations regarding chest x-rays and TB testing, or the facility does not have a policy in place as described in IDH’s “Tuberculosis Assessment and Testing of Long-Term Care Residents,” a deficient practice citation will be written.
The assessment document outlines the following steps upon admission:
- Each resident must have a health assessment upon admission, which outlines any significant past or present infectious diseases and signs and symptoms of TB. The medical record should include the assessment and a statement that the resident shows no evidence of TB in an infectious stage as verified upon admission.
- Routine or baseline chest x-rays are not required or recommended prior to or upon admission.
- New residents should be tested three (3) months prior to or upon admission unless there is documentation of a previous positive TB test. Testing can be conducted via the tuberculin skin test (TST) method or an Interferon Gamma Release Assay (IGRA) blood test.
- Any residents who are positive for TB should then be evaluated as outlined in the IDH’s assessment document.
Questions about these advisory letters may be addressed to Tammy Alley at 317-233-7441 or talley@isdh.in.gov or Brenda Buroker at 317-234-7340 or bburoker@isdh.in.gov.