Dear Colleagues

One of our members has been in correspondence with PHE to ask for information regarding best practice and recommendations for TB screening of NHS workers from high incidence TB countries. In particular, she asked them to clarify the following issues:

• Do all new entrants from a TB endemic country coming to work in the NHS need to have a clear CXR and IGRA/Mantoux test PRIOR to commencement of post.
• The time frame for being in an TB endemic (TBE) country and requiring further screening - is it 4 weeks or is it 3 months, literature is not consistent with this, please confirm. Ie does a new NHS starter who has been in a TBE for 4 weeks still need to go through the same tests that someone who has been in a TBE for >3 months?
• How often does this actually need doing? Many NHS workers move between UK and their home countries throughout the year, spending months in UK and months then back in their home countries which are often TBE., do we do CXR IGRA etc., when they return each time? Do we need a recall system setting up in the NHS to log anyone who goes out of the country for >4 weeks at a time to rescreen them on their return?
• New F1 doctors often do a 4 week Elective placement in TBE areas prior to starting their first  NHS role, do these need full screening too?

We felt it would be helpful to share the response with Network members, which is as follows:

Employees new to the NHS who will be working with patients or clinical specimens should not start work until they have completed a TB screen or health check, i.e. be free from TB disease, or until documentary evidence is provided of such screening having taken place within the preceding 12 months: www.gov.uk/government/publications/new-healthcare-workers-clearance-for-hepatitis-b-and-c-tb-hiv 

Unless a person has been exposed to TB, screening for TB should be reserved for individuals who have lived or worked with local people for more than three months in a country where the annual incidence of TB is 40/100,000 or greater. NICE recommends including reminders of the symptoms of TB, and the need for prompt reporting of such symptoms, with annual reminders about occupational health for staff who: are in regular contact with TB patients or clinical materials or have worked in a high-risk clinical setting for 4 weeks or longer: www.nice.org.uk/guidance/ng33/chapter/recommendations#preventing-infection-in-specific-settings

In addition to annual reminder recommended by NICE (see above), it would be sensible to reinforce and extend local existing measures to reduce the risk of healthcare worker transmission of TB particularly to patients and remind healthcare workers of their responsibility to seek professional advice about the need to be tested if they have been exposed to TB or have symptoms suggestive of TB: www.gov.uk/government/publications/new-healthcare-workers-clearance-for-hepatitis-b-and-c-tb-hiv

New F1 doctors should come under the pre-appointment standard health checks for all new healthcare workers, which includes checks for TB disease/immunity: www.gov.uk/government/publications/new-healthcare-workers-clearance-for-hepatitis-b-and-c-tb-hiv

We hope that you find this information useful.