Workplace Screening Recommendations for Tuberculosis (TB)

Canada has one of the lowest TB rates in the world. Toronto Public Health provides information on TB and recommendations for TB screening in various workplace settings within the City of Toronto. The TB program also offers consultation around TB policies and procedures.

TB Information for Employers

Employees with a positive TB skin test in contact with someone who has TB

Ensure that employee confidentiality is maintained. Call Toronto Public Health (TPH) at 416-338-7600 to report. It is important to remember that only a person with active TB disease can spread the TB germs to others. People who have only a positive skin test (i.e. LTBI) are not sick and cannot spread TB germs. Toronto Public Health will follow up with anyone who has had a contact with someone who has active TB disease.

People with Latent TB Infection (LTBI) in the Workplace

A person with LTBI should not be banned from work. People who have LTBI are not sick, and cannot spread TB germs to others.

People with Active TB Disease in the Workplace

Because people with active TB disease in the lungs or throat can spread the TB germs, it may be necessary for them to take time off work until they have been on treatment long enough that they can no longer spread the TB germs. Support from the employer is important during this time. Toronto Public Health and the employee’s physician will work closely to determine if the individual can safely report to work.

Role of Toronto Public Health

  • A Public Health Nurse (PHN) will help clarify if the employee has latent TB infection or active TB disease by working with the employee’s physician.
  • If the employee has infectious TB disease, a PHN will work with their physician to determine when the employee can safely return to work.
  • To determine if anyone else may be at risk, a PHN will ask the employee about his/her job, such as work hours, working conditions and people who work closely with him/her. The PHN may also need to make a site visit and/or confirm information with a supervisor or occupational health department at the workplace.
  • The PHN may also want to speak to people who regularly visit your workplace.
  • The PHN will ensure that the person with active TB disease receives adequate treatment.
  • An education session for staff at the workplace can be made available if necessary.
  • The PHN will ensure employee confidentiality is maintained throughout the investigation.

 

Recommendations for TB Screening

The Long-Term Care Homes Act, 2007 and Retirement Homes Act, 2010 require that all residents admitted to a long-term care or retirement home be screened for tuberculosis.

Toronto Public Health has updated its recommendations for TB screening for residents of both long-term care and retirement homes. A screening checklist for clinicians is also available.

For more information

Toronto Public Health highly recommends that all staff and volunteers provide documentation of TB testing prior to employment. Daycare/nursery school staff and volunteers need TB skin testing to protect themselves, other staff, volunteers and children. (Volunteers include those who expect to work regularly during the next year – approximately a half day per week or more.)

**The TB skin test should be done anytime within 6 months before the start of employment**

TB Testing and Employment

  1. If a new employee/volunteer does not know their TB status or has had a negative TB skin test result in the past, a single TB skin test is highly recommended.
    • If the TB skin test is negative – no further testing is needed at this time. (People with medical conditions that weaken the immune system, such as HIV or cancer, may have a negative skin test even though they are infected with TB. If you are in this category please speak to your doctor).
    • If the TB skin test is positive- a medical examination and chest x-ray is recommended. Sputum may also be collected. The physician should provide documentation that the individual with a positive TB skin test is free of infectious TB disease before beginning work.
  2. If a new employee/volunteer has had a documented previous positive skin test, the skin test does not need to be repeated – it will always remain positive. However, a medical examination and chest x-ray within 3 months of hire, is recommended to ensure that daycare/nursery school staff and volunteers do not have TB disease.  The physician should provide documentation that the individual with a previous positive TB skin test is free of TB disease before beginning work.
  3. Any employee/volunteer who has a positive TB skin test should be aware of the signs and symptoms of active TB disease. Early diagnosis and treatment of TB disease is critical. If your skin test is positive and you develop signs and symptoms of active TB, see a doctor immediately. 

Where to Get a TB Skin Test

A TB skin test can be done by your family physician, a walk-in clinic or at a neighborhood community health centre. For employment purposes, you generally will have to pay for the TB skin test.

Frequency of TB Skin Tests or Chest X-rays

Employees/volunteers are not required to have annual or periodic skin tests or chest x-rays for TB. Repeat testing is required only if there is an infectious case of TB in the daycare/nursery school. Should this occur, follow-up of the TB case and contacts will be coordinated by Toronto Public Health. Skin testing will be free if you are identified as a contact of a TB case.

Pre-placement TB Testing for Early Childhood Education (ECE) Students

Some daycare/nursery schools participate in Early Childhood Education (ECE) field placements. Many ECE programs require their students to have a TB skin test. If you have ECE students, confirm with their program that they have had their TB skin tests done prior to starting their placement.

TB Testing for Children

Routine TB testing for children is not recommended.

Legislation for Daycare Employment

CCEYA Act: Subsection 7.4: Ontario Regulation 137/15:

57(1) Every licensee of a child care centre shall ensure that, before commencing employment, each person employed in each child care centre it operates has a health assessment and immunization as recommended by the local medical officer of health.

Revised February 2017

TB medicines are free when a doctor orders them from Toronto Public Health. 
TB is preventable, treatable and curable!