HomeResidents of long-term care (LTC) homes are considered to be at the same risk for having latent TB infection as other populations in the community, and have the same risk of developing active TB as persons of the same age in the general population, with the exception of those belonging to identified at-risk groups (see Chapter 6: Tuberculosis Preventive Treatment in Adults, Table 1). However, because of the concern for transmission of TB in LTC homes and the anticipated need for contact tracing should there be an exposure, many guidelines recommend screening newly admitted residents.
Across the Canadian provinces and territories, practices around assessment of new admissions for TB vary. In some provinces/territories, pre-admission and admission screening for symptoms and/or risk of active TB are recommended or mandated. In many provinces, screening for latent TB infection is recommended with a TST and/or chest x-ray, but the criteria for testing vary from all new residents to those who are at increased risk for TB. Some jurisdictions stipulate that the decision for screening should be based on a facility risk assessment and local epidemiology. For discussion and recommendations regarding testing for TB infection in this population, see Chapter 4: Diagnosis of Tuberculosis Infection.
Good practice statements
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An assessment of likelihood of respiratory TB should be done on or before admission to a long-term care home.
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A symptom screen to rule out active TB should be done, preferably prior to, and on admission to a long-term care home.
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A posteroanterior and lateral chest x-ray should be performed if a resident is symptomatic and the resident should be referred for medical assessment if indicated.
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Routine tuberculin skin testing on (or prior to) admission and periodic tuberculin skin tests (such as annually) are not recommended for residents.
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If a resident has had exposure to respiratory TB, the need for testing should be individualized as part of contact tracing.
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