How Often Do You Need a TB Test in Healthcare

Healthcare workers in most places need TB testing when they start a new job, but they don’t need yearly TB tests anymore unless there’s a specific reason. The CDC updated their rules in 2019 and now says routine annual TB testing is not needed unless there is a known exposure or ongoing transmission at a healthcare facility.

This guide will explain everything you need to know about TB testing in healthcare jobs. You’ll learn when you need testing, what types of tests are available, and how to stay compliant with health rules.

What Are the Current CDC Guidelines for TB Testing

The rules for TB testing changed a lot in 2019. According to the Centers for Disease Control and Prevention, all U.S. health care personnel should be screened for tuberculosis (TB) upon hire (i.e., preplacement). This means you need testing before you start work, but the yearly requirement is mostly gone.

New Baseline Testing Requirements

When you get hired for a healthcare job, you must complete three things:

Individual risk assessment
Symptom evaluation
TB test (either blood test or skin test)

The updated recommendations call for health care personnel to be screened for TB upon hire with an individual risk assessment, a symptom evaluation, and a TB test. After this initial screening, most healthcare workers won’t need another TB test unless something specific happens.

When Annual Testing Is Still Required

Routine serial TB screening or testing at any interval after baseline (e.g., annually) of health care personnel is not recommended unless there is a known exposure or ongoing transmission at a healthcare facility. This means you might still need yearly testing if:

You work in an area where TB cases have occurred
Someone at your workplace gets TB disease
Your facility has ongoing TB transmission problems
You’re in a high-risk job like working with lung patients

Who Needs TB Testing in Healthcare

Not every healthcare worker has the same TB testing needs. The rules depend on your job and where you work.

Healthcare Workers Who Need Testing

TB screening programs should include anyone working or volunteering in health care settings. This includes:

Doctors and nurses
Medical assistants and technicians
Respiratory therapists
Emergency room staff
Laboratory workers
Hospital maintenance staff
Volunteers in healthcare facilities

High-Risk Healthcare Positions

Some healthcare jobs have higher TB exposure risks. For employees in high-risk settings, such as respiratory therapists or pulmonologists, annual tuberculosis screening can be considered. These positions might need more frequent testing:

Pulmonologists and lung specialists
TB clinic workers
Emergency department staff
Infectious disease specialists
Workers in areas with previous TB cases

Types of TB Tests Available

You have two main options for TB testing. Both tests can tell if you have TB bacteria in your body, but they work differently.

TB Skin Test (TST)

The tuberculin skin test has been around the longest. The TB skin test involves injecting a small amount of a fluid called tuberculin into the skin of the arm. Here’s how it works:

A healthcare worker injects tuberculin under your skin
You wait 48 to 72 hours
A healthcare worker checks for swelling or redness
You need two visits to complete the test

The skin test has some downsides. The TB skin test requires a minimum of two visits and can cross-react with the common BCG vaccine. If you got the BCG vaccine, you might get a false positive result.

TB Blood Test (IGRA)

Blood tests are newer and more accurate. A TB skin test requires injecting tuberculin under the skin and checking the reaction 2–3 days later, while a TB blood test measures the immune response from a blood sample.

The most common blood tests are:

QuantiFERON-TB Gold Plus
T-SPOT TB test

Research published in the American Family Physician journal shows that QFT has been shown to be more accurate than the TST in identifying people who may have latent TB infection. Blood tests offer several advantages:

Only one visit needed
More accurate results
Not affected by BCG vaccine
No risk of injection site reaction

How Often Different Healthcare Settings Require Testing

Testing frequency can vary by state and facility type. Let’s look at what different places require.

Hospital Requirements

Most hospitals follow CDC guidelines for baseline testing only. However, some hospitals in high-risk areas might require annual testing for certain departments.

Long-Term Care Facilities

Nursing homes and care facilities often have their own rules. If you’re admitted to a care home for the elderly or you begin working in a care home, you should receive a TB skin test as soon as your residency or employment begins.

State-Specific Requirements

CDC recommendations do not override or replace state regulations. State and local regulations may differ to meet local needs. According to the Pennsylvania Department of Health, some states still require annual testing:

California requires annual TB testing for many healthcare workers
Some states have specific rules for different facility types
Check with your state health department for local requirements

When You Need Additional TB Testing

Even though annual testing isn’t usually required, there are times when you need extra TB tests.

After TB Exposure

If you work in healthcare and have knowingly been exposed to TB disease, you should receive a TB symptom screen and testing. The timing matters:

Get tested right away after exposure
Have a follow-up test 8 to 10 weeks later
Use the same type of test for both tests

If You Have Symptoms

You should get tested immediately if you develop TB symptoms like:

Cough lasting more than 3 weeks
Unexplained weight loss
Night sweats
Fever
Loss of appetite
Coughing up blood

Job Changes Within Healthcare

When you change jobs or departments, you might need new testing. This depends on:

Your new workplace’s policies
Whether you’re moving to a higher-risk area
How long it’s been since your last test

What Happens If Your TB Test Is Positive

A positive TB test doesn’t mean you have active TB disease. A positive TB test indicates that a person has been infected with TB bacteria. It does not specify whether the person has latent TB infection (LTBI) or has progressed to TB disease.

Next Steps After a Positive Test

A positive test result usually means TB infection. More tests, such as a chest radiograph, are needed to rule out TB disease. Your doctor will:

Order a chest X-ray
Ask about symptoms
Possibly order additional tests
Determine if you have latent or active TB

Treatment Considerations

Treatment is strongly encouraged for health care personnel diagnosed with latent TB infection. Modern treatments are shorter and easier to complete than older options.

For healthcare workers with untreated latent TB, health care personnel with untreated latent TB infection should receive a yearly TB symptom screen.

According to the American Association of Physician Assistants, shorter treatment regimens, including once-weekly isoniazid and rifapentine for 3 months and daily rifampin for 4 months, are now preferred because they have higher completion rates.

Cost and Practical Considerations

Understanding the costs and logistics of TB testing helps you plan better.

Test Costs and Coverage

QuantiFERON TB testing is cost-effective compared to the tuberculin skin test. The TST requires multiple visits, and increased false-positive results from prior BCG-vaccination can lead to unnecessary treatment and waste of resources.

Most employers cover the cost of required TB testing. If you need testing for work physicals, many healthcare providers offer convenient scheduling.

Scheduling and Results

Blood tests are usually more convenient:

One appointment only
Results in 1-3 days
No need to return for reading

Skin tests require more planning:

Initial appointment for injection
Return visit in 48-72 hours
Must be read within the time window

Special Situations and Exceptions

Some healthcare workers have unique TB testing needs.

Previous Positive Test Results

If you have had a positive TB test in the past, you do not need another test following exposure to TB disease. Instead, you get symptom screening to check for active disease.

Pregnant Healthcare Workers

Pregnant women can safely get TB tests, but there may be special forms or procedures. Some facilities have exemption forms for pregnant workers who prefer to delay testing.

Immunocompromised Workers

Healthcare workers with weakened immune systems might need:

Both blood and skin tests
More frequent testing
Additional monitoring

Staying Compliant With TB Testing Requirements

Keeping up with TB testing requirements protects both you and your patients.

Documentation Requirements

Keep records of:

All TB test results
Dates of testing
Any treatment you received
Symptom screening results

Annual Education Requirements

All healthcare personnel should receive annual TB education. This education covers:

TB risk factors
Signs and symptoms of TB disease
Infection control policies
When to seek testing

Working With Occupational Health

Most healthcare facilities have occupational health programs that handle TB testing. They can help you:

Schedule required tests
Understand your facility’s specific policies
Navigate state and local requirements
Plan testing around your work schedule

Final Thoughts

TB testing rules for healthcare workers have changed significantly. Most healthcare workers now only need baseline TB testing when hired, not annual testing. However, you might still need yearly tests if you work in high-risk areas or have known exposures.

The key points to remember:

Get baseline testing when you start any healthcare job
Annual testing usually isn’t required anymore
Blood tests are more accurate and convenient than skin tests
State rules might be different from federal guidelines
Always get tested if you have symptoms or known exposure

If you need TB testing in Vernon Hills, Yorktown Health offers both skin and blood tests with convenient scheduling. We also provide comprehensive annual physicals and other occupational health services to keep you healthy and compliant with work requirements.