TB Screening Recommendations for Employment

Recommendations for All Health Care Settings

The Windsor-Essex County Health Unit strongly recommends that all employees/volunteers in all healthcare settings have pre-employment baseline TB screening, which includes:

1. An individual risk assessment that identifies risks for TB, including:
   1. Temporary or permanent residence in a high-incidence country (total TB incidence of ≥ 50/100,000)
   2. Prior TB disease
   3. Current or planned immune suppression
   4. Close contact with someone who has had infectious TB since the last tuberculin skin test (TST)
2. A symptom evaluation
3. A TST for those without documentation of a previous positive TST or prior TB disease.

For information on when a two-step TST is required, refer to Two-Step Tuberculin Skin Test (TST).

Employees/volunteers with a positive TST result should be assessed for active TB disease, including a chest x-ray and a medical evaluation.

Employees/volunteers with a documented previous positive TST or previous positive interferon-gamma release assay (IGRA) result do not need repeat testing for pre-employment screening. However, assessment for active TB disease is recommended, including a chest x-ray and a medical evaluation.

Supplying agencies/schools are responsible for the pre-placement TB screening of contract workers/students. TB screening completion should be confirmed with agencies/schools prior to the start of the placement.

In general, the Windsor-Essex County Health Unit does not recommend periodic TSTs or chest x-rays (i.e., annual testing). However, acute care settings may determine the need for periodic TSTs based on an organizational risk assessment.

Repeat screening is only recommended if an infectious case of TB disease is identified in the workplace. Should this occur, follow-up of the TB case and contacts will be coordinated by the Windsor-Essex County Health Unit, in collaboration with the workplace.

Reference: Canadian Thoracic Society & Public Health Agency of Canada (2022). Canadian Tuberculosis Standards (8th Edition).

Recommendations for Non-Health Care Settings

The Windsor-Essex County Health Unit does not require pre-employment baseline TB screening for non-health care settings in Windsor and Essex County, including schools and daycares.

Employees/volunteers are also not recommended to have periodic TSTs (i.e., annual testing).

TB screening is only recommended if an infectious case of TB disease is identified in the workplace. Should this occur, follow-up of the TB case and contacts will be coordinated by the Windsor-Essex County Health Unit, in collaboration with the workplace.