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accordance with the recommendations of the American College of Chest Physicians or the

section on diseases of the chest of the American Academy of Pediatrics, or both.

Guidance §483.460(a)(3)(iv)

The facility should have in place a system for the identification, reporting, investigation, and

control of Tuberculosis (TB) in order to prevent its transmission within the facility. This system

should include:

1) Policies and procedures for screening new employees, new clients, and other people

who interact on a consistent basis with clients residing in the facility when those

persons are volunteers or professional staff hired or utilized directly by the facility

(such as volunteers and contract professional staff);

2) Policies and procedures for subsequent screening for clients and for employees, and

other people (such as volunteers and contract professional staff) who interact on a

consistent basis with clients residing in the facility when those persons are volunteers

or professional staff hired or utilized directly by the facility per State Health

Department requirements;

3) Policies and procedures for reporting positive TB test results to the appropriate State

authorities;

4) Policies for the investigative procedures, per the local health department, that would

be put in place should a client or staff person test positive for TB;

5) Policies and procedures for treatment and precautions to be used with clients who

display TB symptoms, as substantiated by positive skin testing or x-ray results; and

6) Policies and procedures for the evaluation of the effectiveness of the surveillance

system.

When one or more clients or staff display TB symptoms, as substantiated by positive skin testing

or x-ray results, they do not return to work until a physician has cleared them to return to work.