Tuberculosis Compliance Checklist for Student Nurses: A Comprehensive Guide
Entering the nursing profession requires meticulous attention to detail and a commitment to patient safety. A crucial aspect of this commitment involves adhering to strict health and safety compliance measures, particularly concerning tuberculosis (TB). This article serves as a comprehensive checklist and guide for student nurses to navigate the TB compliance requirements often mandated by universities, nursing programs, and clinical sites.
Initial Screening and Documentation
The first step in TB compliance is typically demonstrating the absence of active TB disease upon entering the nursing program. This often involves providing documentation of one of the following:
- Two TB skin tests (TST) within 12 months of each other: The most recent TST must be within one year of the first day of class. If a TB skin test has never been completed previously, a 2-step TB skin test is required. A 2-step TB skin test consists of two TB skin tests 1-3 weeks apart.
- One IGRA blood test: A single IGRA blood test (Interferon-Gamma-Release Assay, such as Quantiferon Gold for TB or T-Spot) may be completed in lieu of TB skin testing.
It's important to note that previous vaccination with BCG may produce a positive TST. Therefore, individuals with a history of BCG vaccination should be screened for TB with a TB blood test. There is no interaction between the BCG vaccine and the TB blood test. Also, be aware if receiving a live virus immunization (such as varicella, MMR or Flu), you will need to have your TST done either at the same time or wait 4 weeks.
Understanding TB Testing: TST vs. IGRA
Two primary methods exist for detecting TB infection: the Tuberculin Skin Test (TST), also known as the Mantoux test, and Interferon-Gamma Release Assays (IGRAs), which are TB blood tests.
- Tuberculin Skin Test (TST): This test involves injecting a small amount of fluid (tuberculin) into the skin of the lower arm. The individual must return within 48 to 72 hours to have a trained healthcare worker assess for a reaction. The skin test does not meet the requirements of the university's tuberculosis screening policy.
- Interferon-Gamma Release Assays (IGRAs): These blood tests measure how the patient’s immune system reacts to TB germs.
A positive TST or IGRA likely indicates exposure to TB bacteria. However, it does not differentiate between latent TB infection and active TB disease. Further testing, such as a chest X-ray, is required to determine the presence of active TB disease.
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Latent TB Infection vs. TB Disease
Understanding the difference between latent TB infection and TB disease is crucial:
- Latent TB Infection (LTBI): Individuals with LTBI have TB germs in their bodies, but the germs are inactive. They do not experience symptoms and cannot spread the infection. However, they are at risk of developing TB disease in the future.
- TB Disease: Individuals with TB disease have active TB germs that are multiplying and destroying tissue. They typically experience symptoms and can spread the infection to others, especially through coughing, sneezing, speaking, or singing.
Treatment for Latent TB Infection and TB Disease
- Latent TB Infection: Treatment typically involves a course of medication to kill the inactive TB germs and prevent the development of active TB disease. Generally, a person with latent TB infection has a 10% chance of developing active TB disease in their lifetime. Some people are more likely than others to develop TB disease once they have TB infection. This includes people with HIV infection, people who were recently exposed to someone with TB disease and people with certain chronic medical conditions.Latent TB infection is treated with two TB drugs (Isoniazid & Rifapentine) once weekly for 12 weeks by direct observation therapy. Completion of treatment for latent TB infection reduces a person's risk for developing active TB disease from 10% to less than 1%.
- TB Disease: Treatment for TB disease requires a more intensive regimen involving multiple medications taken for several months.
Additional Compliance Requirements for Nursing Students
Beyond TB screening, nursing students often face a range of other compliance requirements, including:
- Background Check: To be ordered through ClinicalStudent. Once completed results will automatically upload to your account.
- FCSR: To be ordered through ClinicalStudent.
- Drug Screening: All nursing students are subject to a urinary drug screening. Screenings will be ordered through ClinicalStudent. Deadline to deposit urine sample will be given by Validity Screening Solution, students must follow the assigned deadline. Results will be automatically uploaded to your account.
- COVID-19 Vaccination: Provide proof of a completed COVID-19 vaccine series - 1 Johnson & Johnson, 2 Pzifer or Moderna before May 2023. After May 2023, 1 dose bivalent will meet requirement.
- Basic Cardiac Life Support (BLS): Documentation includes proof of current BLS Healthcare Provider certification taken through the American Heart Association and must be BLS CPR & AED for Healthcare Professionals course. This must be kept current throughout the program. Make sure the course is truly an American Heart Association course and not just listed as “AHA” standards. Courses for lay rescuers such as “HeartSavers” are not acceptable. Courses may include an online portion but must include a hands-on validation of skills. The American Red Cross is not acceptable certification for this requirement. Upload both the front and back of your BLS certification card. Note: Following completion of a class, it can take up to a week to receive your certification card so plan accordingly with our due date in mind.
- Hepatitis B Immunization: Adequate documentation of a complete series: Three immunizations taken over a period of 6 months is a complete series. The second Hep B immunization must be given no earlier than 4 weeks from the first, and the third given no earlier than 6 months from the first immunization. Students must have at least the first two immunizations in the series documented and uploaded before beginning clinical. Though not recommended because of the risk of Hepatitis B, this vaccine can be waived but a signed waiver must be completed.
- Annual Seasonal Flu Vaccine: Provide proof of seasonal flu vaccine which includes injection site, route, and signature of vaccinator. Important: Immunizations are required for clinical including the Covid and flu vaccine. Clinical agencies may not provide exemptions. The only exemption that may be acceptable by the agencies is a true allergy which requires lab work documentation as proof of the allergy to the vaccine. Any delays in vaccinations or asking for an exception may change the order of classes or delay completion of the program.
- Student Handbook Quiz and Acknowledgment: Read the current Jewell Nursing Student Handbook.
- Clinical Orientation Manual and Exam: Read the Clinical Orientation Manual located in the shared files folder of ClinicalStudent, then complete the quiz with a score of 90% or higher. You may take the exam multiple times.
- Student Health Insurance: Download form from ClinicalStudent, sign, upload to ClinicalStudent.
- Proof of Health Insurance: Documentation includes your current health insurance card as proof that you have health insurance coverage for the current academic year. Only the front of the card needs to be provided as long as it includes the company name, policy holder, and policy number. Please familiarize yourself with our student compliance policy for new students. William Jewell College is a member of CNE (Collegiate Nurse Educators of Greater Kansas City) working to ensure students demonstrate the competency and complete the orientation required in the clinical setting. The Clinical Orientation Manual and Exam are used to provide a general orientation for all students. Ultimately, students are expected to follow the policies and procedures of the institution they are assigned. Many clinical partners have orientation and paperwork requirements above and beyond the general Clinical Orientation Manual and the program compliance outlined therein. These requirements are mandatory.
Maintaining Compliance Throughout the Program
Compliance is not a one-time event. Student nurses must maintain compliance throughout their program by:
- Keeping all certifications and immunizations current.
- Adhering to deadlines for submitting documentation.
- Staying informed about any changes in requirements.
- Complying with the policies and procedures of clinical sites.
Addressing Potential Issues
- Positive TB Test: A positive TB test requires further evaluation to determine if it represents latent TB infection or active TB disease.
- Exemptions: While some exemptions to vaccination requirements may be possible, they are often limited and may require documentation, such as lab work proving a true allergy.
- Delays: Delays in vaccinations or other compliance requirements can impact the order of classes or delay program completion.
Resources and Support
Universities and nursing programs typically provide resources and support to help students navigate compliance requirements. These resources may include:
- Student health centers
- Compliance offices
- Program handbooks
- Online portals
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tags: #tuberculosis #compliance #checklist #student #nurse
