The Centers for Disease Control and Prevention (CDC) recommends all U.S. HCWs be screened for LTBI at the time of initial hire (preplacement), regardless of risk classification.7 The screening can be either the TST or an IGRA blood test. If the TST is used, it should be the two-step method except under these conditions:
- The newly hired health care worker has a positive first test.
- The newly hired health care worker has a documented negative TST result from testing that was performed within the last 12 months.
- The newly hired health care worker has two or more previously documented negative TSTs, even though the most recent was more than 12 months before new employment.
If the initial TST is positive, or the second test is positive, the individual must undergo additional testing to evaluate the presence of TB disease. If TB disease is excluded, the health care worker should be treated for LTBI, unless this is not medically possible.
