TB Testing PolicyAll students who will have clinical exposure to patients need to be in compliance with TB testing.Pre-Placement (students who will begin in the clinical environments) All students need to fill out the TB symptom questionnaire. - Students who are asymptomatic AND have had no hx of positive PPD or BCG vaccination should receive either:
- 2 step PPD testing
This consists of one PPD placed and if negative, a second PPD placed within 28 days.
Students will only require one additional PPD test (considered the second test) if they have had a PPD for any reason within 90 days of beginning in the clinical setting, with the exception of repeat testing required for foreign travel or other post-exposure testing (see below). Documentation of the actual test result must be provided. - Blood Assay for Mycobacterium tuberculosis (BAMT, e.g., Quantiferon Gold)
Students will not require repeat testing if they have had a BAMT for any reason within 90 days of beginning in the clinical setting, with the exception of repeat testing required for foreign travel or other post-exposure testing (see below). Documentation of the actual test result must be provided.
Students who test positive on either the PPD or the BAMT will need a chest xray and follow up in student health for discussion of treatment. - Students who are asymptomatic AND have a hx of prior positive PPD or BCG vaccination should receive:
- BAMT
Students who have had a BAMT for any reason prior to beginning in the clinical setting must show documentation of the result and the test must have been performed within 90 days of beginning in the clinical setting. - Chest X Ray (CXR)
Students who have had a CXR within 6 months of beginning clinical rotations will not need to have any further pre-placement testing.
Symptomatic students should be given a surgical or procedure mask and sent to Student Health for CXR with further management dependent on CXR findings and clinical evaluation. Annual Testing All students need to fill out the TB symptom questionnaire Asymptomatic Students will need either
a. Annual PPD testing
b. Annual BAMT Students whose PPD or BAMT are positive are considered converters and will need a CXR and follow up in student health for discussion of treatment. Symptomatic students should be given a respiratory mask and sent to Student health for CXR with further management dependent on CXR findings and clinical evaluation Exposure Surveillance All students involved in an exposure will require a baseline test as soon as possible after the exposure and then a repeat test 10 weeks later. Converters will need a CXR and evaluation in Infectious Disease clinic for discussion of treatment Foreign Travel All students who have traveled to countries other than the US, Canada, or Western Europe must have TB testing 8 to 10 weeks after return to the US. Symptomatic students should be given a surgical or procedure mask and sent to Student Health for CXR with further management dependent on CXR findings and clinical evaluation. Respiratory Surveillance and Fit Testing All students must have annual respiratory surveillance and fit testing at NMH Corporate Health Department | 
