Fillable Baseline Individual TB Risk Assessment HCP should be (Centers For Disease Control and Prevention)

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Baseline Individual TB Risk Assessment HCP should be (Centers For Disease Control and Prevention)

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Health Care Personnel (HCP)
Baseline Individual TB Risk Assessment
HCP should be considered at increased risk for TB if
any of the following statements are marked “Yes”:
Temporary or permanent residence of ≥1 month
in a country with a high TB rate
Any country other than the United States, Canada, Australia, New Zealand,
and those in Northern Europe or Western Europe
YES
NO
OR
Current or planned immunosuppression,
including human immunodeficiency virus (HIV) infection, organ transplant
recipient, treatment with a TNF-alpha antagonist (e.g., infliximab, etanercept, or
other), chronic steroids (equivalent of prednisone ≥15 mg/day for ≥1 month) or
other immunosuppressive medication
YES
NO
Close contact with someone who has had
infectious TB disease since the last TB test
OR
YES
NO
Abbreviations: HCP, health-care personnel; TB, tuberculosis; TNF, tumor necrosis factor.
Individual risk assessment information can be useful in interpreting TB test results (see
Lewinsohn DM, Leonard MK, LoBue PA, et al. Official American Thoracic Society/Infectious
Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice
Guidelines: Diagnosis of tuberculosis in adults and children. Clin Infec Dis 2017;64:111–5).
Adapted from: Risk assessment form developed by the California Department of Health,
Tuberculosis Control Branch.
Sosa LE, Njie GJ, Lobato MN, et al. Tuberculosis Screening, Testing, and Treatment of U.S.
Health Care Personnel: Recommendations from the National Tuberculosis Controllers
Association and CDC, 2019. MMWR Morb Mortal Wkly Rep 2019;68:439–43.
https://www.cdc.gov/mmwr/volumes/68/wr/mm6819a3.htm?s_cid=mm6819a3_w
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Completed 9 October 2020

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