Recommendations from the Minnesota Department of Health (MDH) for Completing the CDC Facility TB Risk Assessment Worksheet The Facility TB Risk Assessment Worksheet, developed by the Centers for Disease Control and Prevention (CDC), is available at www.health.state.mn.us/divs/idepc/diseases/tb/rules/mmwrb.pdf. This worksheet is Appendix B in Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005, published by the CDC (www.cdc.gov/tb/publications/guidelines/infectioncontrol.htm). A separate Facility TB Risk Assessment Worksheet is required for each type of license. A separate Facility TB Risk Assessment Worksheet is required for each physical address. Indicate n/a or not applicable for questions that don t apply to your health care setting. Questions about completing this worksheet should be directed to the MDH TB Prevention and Control Program at 651-201-5414. Section 1: Incidence of TB 1a. Contact the MDH TB Prevention and Control Program (651-201-5414) for assistance with interpreting TB case rates and case numbers. Data for 2017 will be available in May 2018. Risk assessments conducted early in the calendar year (before new data are posted) should use data from the previous year. Community rate = county rate State rate: National rate: County-specific case rates and numbers for 2016 are listed in the table below. Health care settings in Hennepin, Olmsted, and Ramsey counties: record the case rate. Health care settings outside of Hennepin, Olmsted, and Ramsey counties: record the number of cases. MDH does not calculate TB incidence rates for other counties. Health care settings that serve persons from multiple counties should record the rate or number for each county. In 2016, the case rate of active TB disease in Minnesota was 3.1 per 100,000 population. In 2016, the case rate of active TB disease in the United States was 2.9 per 100,000 population. Cases of Active TB Disease by County, Minnesota, 2016 County # of Cases Case Rate Aitkin 0 Record the county s case number Anoka 7 Record the county s case number Becker 0 Record the county s case number Minnesota Department of Health, TB Prevention and Control Program page 1
County # of Cases Case Rate Beltrami 0 Record the county s case number Benton 0 Record the county s case number Big Stone 0 Record the county s case number Blue Earth 3 Record the county s case number Brown 0 Record the county s case number Carlton 0 Record the county s case number Carver 0 Record the county s case number Cass 0 Record the county s case number Chippewa 0 Record the county s case number Chisago 0 Record the county s case number Clay 1 Record the county s case number Clearwater 0 Record the county s case number Cook 0 Record the county s case number Cottonwood 1 Record the county s case number Crow Wing 0 Record the county s case number Dakota 6 Record the county s case number Dodge 0 Record the county s case number Douglas 0 Record the county s case number Faribault 0 Record the county s case number Fillmore 0 Record the county s case number Freeborn 0 Record the county s case number Goodhue 0 Record the county s case number Grant 0 Record the county s case number Hennepin 73 6.0 per 100,000 population Houston 0 Record the county s case number Hubbard 0 Record the county s case number Isanti 1 Record the county s case number Itasca 0 Record the county s case number Jackson 0 Record the county s case number Kanabec 0 Record the county s case number Kandiyohi 1 Record the county s case number Kittson 0 Record the county s case number Koochiching 0 Record the county s case number Lac Qui Parle 0 Record the county s case number Lake 0 Record the county s case number Lake of the Woods 0 Record the county s case number Le Sueur 0 Record the county s case number Lincoln 0 Record the county s case number Lyon 0 Record the county s case number McLeod 0 Record the county s case number Mahnomen 0 Record the county s case number Marshall 0 Record the county s case number Martin 1 Record the county s case number Minnesota Department of Health, TB Prevention and Control Program page 2
County # of Cases Case Rate Meeker 0 Record the county s case number Mille Lacs 0 Record the county s case number Morrison 0 Record the county s case number Mower 0 Record the county s case number Murray 0 Record the county s case number Nicollet 0 Record the county s case number Nobles 5 Record the county s case number Norman 0 Record the county s case number Olmsted 11 7.3 per 100,000 population Otter Tail 1 Record the county s case number Pennington 0 Record the county s case number Pine 0 Record the county s case number Pipestone 0 Record the county s case number Polk 3 Record the county s case number Pope 0 Record the county s case number Ramsey 40 7.4 per 100,000 population Red Lake 0 Record the county s case number Redwood 0 Record the county s case number Renville 0 Record the county s case number Rice 0 Record the county s case number Rock 0 Record the county s case number Roseau 0 Record the county s case number St. Louis 1 Record the county s case number Scott 1 Record the county s case number Sherburne 1 Record the county s case number Sibley 0 Record the county s case number Stearns 8 Record the county s case number Steele 0 Record the county s case number Stevens 0 Record the county s case number Swift 0 Record the county s case number Todd 0 Record the county s case number Traverse 0 Record the county s case number Wabasha 0 Record the county s case number Wadena 0 Record the county s case number Waseca 0 Record the county s case number Washington 2 Record the county s case number Watonwan 0 Record the county s case number Wilkin 0 Record the county s case number Winona 1 Record the county s case number Wright 0 Record the county s case number Yellow Medicine 0 Record the county s case number TOTAL 168 3.1 per 100,000 population Minnesota Department of Health, TB Prevention and Control Program page 3
1b. Facility and department rate: Health care settings are not required to calculate a facility or department rate. 1c1. Record the number of patients with suspected or confirmed active TB disease encountered in your health care setting in the past year. If you do not currently collect this data you should establish a system to track this information. 1c2. All health care settings in Minnesota must have up-to-date TB infection control procedures designed to ensure early identification, isolation, and transfer of patients with suspected or confirmed active TB disease. Additional information is available at www.health.state.mn.us/divs/idepc/diseases/tb/rules/index.html. Section 2: Risk Classification 2a. Inpatient settings: 2a2. Record the number of patients with confirmed active TB disease in the past year. If you do not currently collect this data you should establish a system to track this information. 2a3. Determine your health care setting s risk classification using the number of inpatient beds, the number of cases of active TB disease in the past year, and the chart in Appendix C (www.health.state.mn.us/divs/idepc/diseases/tb/rules/mmwrc.pdf). Note: If the infection control team is unsure whether to classify a health care setting as low risk or medium risk, the health care setting should be classified as medium risk. Health care settings that are classified as low risk but serve or employ significant numbers (more than approximately 50%) of people who have elevated risk* (see page 5) for TB should strongly consider increasing their risk classification to medium. All correctional facilities should be classified as medium risk or higher. 2a4. All health care settings in Minnesota must have up-to-date TB infection control procedures designed to ensure early identification, isolation, and transfer of patients with suspected or confirmed active TB disease. Additional information is available at www.health.state.mn.us/divs/idepc/diseases/tb/rules/index.html. 2b. Outpatient settings: 2b1. Record the number of patients with confirmed active TB disease in the past year. If you do not currently collect this data you should establish a system to track this information. 2b10. Determine your health care setting s risk classification using the number of cases of active TB disease in the past year and the chart in Appendix C (www.health.state.mn.us/divs/idepc/diseases/tb/rules/mmwrc.pdf). Note: If the infection control team is unsure whether to classify a health care setting as low risk or medium risk, the health care setting should be classified as medium risk. Health care settings that are classified as low risk but serve or employ significant numbers (more than approximately 50%) of people who have elevated risk* (see page 5) for TB should strongly consider increasing their risk classification to medium. All correctional facilities should be classified as medium risk or higher. 2b11. All health care settings in Minnesota must have up-to-date TB infection control procedures designed to ensure early identification, isolation, and transfer of patients with suspected or confirmed active TB disease. Additional information is available at www.health.state.mn.us/divs/idepc/diseases/tb/rules/index.html. 2c. Nontraditional facility-based settings: Nontraditional health care settings include boarding care homes, correctional facilities, home care agencies, nursing homes, supervised living facilities, and homeless shelters. Minnesota Department of Health, TB Prevention and Control Program page 4
2c1. Record the number of patients/clients with confirmed active TB disease in the past year. If you do not currently collect this data you should establish a system to track this information. 2c9. All health care settings in Minnesota must have up-to-date TB infection control procedures designed to ensure early identification, isolation, and transfer of patients with suspected or confirmed active TB disease. Additional information is available at www.health.state.mn.us/divs/idepc/diseases/tb/rules/index.html. 2c10. Determine your health care setting s risk classification using the number of cases of active TB disease in the past year and the chart in Appendix C (www.health.state.mn.us/divs/idepc/diseases/tb/rules/mmwrc.pdf). Note: If the infection control team is unsure whether to classify a health care setting as low risk or medium risk, the health care setting should be classified as medium risk. Health care settings that are classified as low risk but serve or employ significant numbers (more than approximately 50%) of people who have elevated risk* (see page 5 for TB should strongly consider increasing their risk classification to medium. All correctional facilities should be classified as medium risk or higher. * Elevated risk for TB includes: Ever homeless Ever been incarcerated Foreign-born from (or extensive travel to) high-prevalence countries (go to http://wwwnc.cdc.gov/travel/yellowbook/2014/chapter-3-infectious-diseases-related-totravel/tuberculosis for a map of countries with a high prevalence of TB) HIV-infected Immunocompromised Injection of illegal drugs Substance abuse, including chronic alcoholism Note: MDH acknowledges that this information might not be ascertained from employees. Section 3: Screening of Health Care Workers (HCWs) for M. tuberculosis Infection 3a. All health care settings are required to have a TB screening program for HCWs. At a minimum, this includes baseline screening at the time of hire. The need for and frequency of serial TB screening for HCWs is determined by your health care setting s risk classification (see 2a3, 2b10, or 2c10). Guidance for developing a TB screening program for HCWs can be found at www.health.state.mn.us/divs/idepc/diseases/tb/rules/index.html. 3b-c. Baseline TB screening at the time of hire is required for all HCWs in Minnesota. Baseline TB screening consists of: (1) assessing for current symptoms of active TB disease, (2) assessing TB history, and (3) testing for the presence of infection with Mycobacterium tuberculosis by administering either a two-step tuberculin skin test (TST) or single TB blood test. 3d. Serial TB screening is not required in low-risk health care settings but is required in medium-risk settings. 3e-f. All reports or copies of the TST or TB blood test and any chest radiographs and medical examinations conducted must be maintained in the employee's record Minnesota Department of Health, TB Prevention and Control Program page 5
3h-j. Guidance for calculating conversion rates can be found on pages 13 and 32-34 of Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005 (www.cdc.gov/tb/publications/guidelines/infectioncontrol.htm). Acceptable conversion rates will vary by health care setting. If your facility has a higher-than-expected conversion rate, please contact the MDH TB Prevention and Control Program (651-201-5414). Section 4: TB Infection Control Program 4a. All health care settings in Minnesota must have up-to-date TB infection control procedures designed to ensure early identification, isolation, and transfer of patients with suspected or confirmed active TB disease. Guidance for creating and implementing a TB infection control plan can be found at www.health.state.mn.us/divs/idepc/diseases/tb/rules/index.html. 4d. The infection control plan should be reviewed periodically. MDH recommends that medium-risk health care settings review their infection control plan yearly and low-risk health care settings review their plan every other year. 4f. The TB infection control committee is responsible for the health care setting s TB infection control program. Small settings may have an infection control committee of one or two persons. Groups to consider including on your infection control committee include infection preventionists, physicians, nurses, epidemiologists, engineers, pharmacists, laboratory personnel, health and safety staff, administrators, and risk assessors/quality control staff. Section 5: Implementation of the TB Infection Control Plan Based on Review by the Infection Control Committee 5a. Each health care setting must designate one person to be responsible for the infection control program. 5f. Initial and ongoing HCW TB training and education is required. Suggested content is listed at www.health.state.mn.us/divs/idepc/diseases/tb/rules/mmwr1416.pdf. Section 6: Laboratory Processing of TB-Related Specimens, Tests, and Results Based on Laboratory Review Consult with your health care setting s laboratory for assistance with this section. Section 7: Environmental Controls Consult with your health care setting s environmental engineer for assistance with this section. Section 8: Respiratory Protection Program 8a. Health care settings in which patients with suspected or confirmed active TB disease are expected to be encountered are required to have a respiratory protection program. Guidance for creating a written respiratory protection policy can be found in Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005 (www.cdc.gov/tb/publications/guidelines/infectioncontrol.htm). 8c. Questions regarding respirators should be directed to the Minnesota Occupational Safety and Health Administration (MN-OSHA) at 651-284-5050 or osha.compliance@state.mn.us. Minnesota Department of Health, TB Prevention and Control Program page 6
Section 9: Reassessment of TB Risk 9a. The TB risk assessment should be reviewed and updated periodically. MDH recommends that medium-risk health care settings update their risk assessment worksheet yearly and low-risk health care settings update their worksheet every other year. Minnesota Department of Health, TB Prevention and Control Program page 7