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TB Screening for Healthcare Workers

Every hospital and nursing home wants to see TB screening for the staff your agency sends. In 2019, CDC and the National Tuberculosis Controllers Association updated the screening recommendations for U.S. health care personnel. One big change: routine yearly testing is no longer recommended for most staff. This guide explains what CDC recommends and what to keep in each worker's file.

Updated October 3, 2026 · Checked against official CDC and OSHA sources

Where the current recommendations come from

The current guidance is "Tuberculosis Screening, Testing, and Treatment of U.S. Health Care Personnel: Recommendations from the National Tuberculosis Controllers Association and CDC, 2019." It was published in MMWR 2019;68(19):439-443.

It updates the health care personnel parts of CDC's 2005 TB guidelines for health care settings. The report says parts of the 2005 guidelines outside staff screening, testing, treatment, and education remain unchanged.

Baseline screening at hire

CDC says all U.S. health care personnel should be screened for TB upon hire (preplacement). The 2019 report lists three parts. CDC's web page adds further evaluation for TB disease when needed.

The risk assessment asks about a few things. CDC's 2019 report says a worker is at increased risk if they say yes to any of these: lived for at least one month in a country with a high TB rate, current or planned immunosuppression, or close contact with someone who has had infectious TB disease.

• An individual TB risk assessment (new in 2019).
• A TB symptom evaluation.
• A TB test, either a blood test (IGRA) or a skin test (TST), for anyone without documented prior TB disease or latent TB infection (LTBI).

Two-step skin tests

If a skin test is used for the baseline, CDC says to use two-step testing. If the first skin test is negative, a second skin test is given 1 to 3 weeks after the first result is read.

Why two steps? CDC explains that some people with latent TB infection test negative years after they were infected. If tested again within a year, they may test positive. The second test helps keep that "boosted" reaction from being mistaken for a new infection later.

A blood test (IGRA) does not need two steps. CDC's 2005 guidelines also said baseline screening should use "two-step TST or a single BAMT" (BAMT means a blood assay for Mycobacterium tuberculosis, which is a TB blood test).

• Skin test baseline: two tests, 1 to 3 weeks apart, if the first is negative.
• Blood test baseline: one test.

Workers with a prior positive test or latent TB

If a worker has a documented prior positive TB test, CDC says repeating the TB test is not required. Instead, the worker should get the risk assessment and a symptom screen at hire. They should also get a chest x-ray, or give documentation of a normal chest x-ray. CDC says repeat chest x-rays are not required unless the worker develops signs or symptoms of TB disease.

If a worker tests positive but has no symptoms, is unlikely to be infected, and is at low risk, the 2019 report says they should have a second test, as recommended in CDC's 2017 TB diagnostic guidelines.

Treatment is encouraged for all health care personnel with untreated latent TB infection, unless it is medically contraindicated. Workers who do not complete treatment should have a symptom evaluation every year to catch early signs of TB disease.

Testing after a TB exposure

When an exposure is recognized, all exposed health care personnel should have a symptom evaluation.

Workers with a negative baseline test and no prior TB disease or latent TB infection should be tested when the exposure is identified. If that test is negative, they should be tested again 8 to 10 weeks after the last exposure.

• Symptom evaluation for everyone exposed.
• A TB test right away for those with a negative baseline.
• A second test 8 to 10 weeks after the last exposure if the first is negative.

Yearly testing: what CDC says and what facilities may still ask

The 2019 report says that, without a known exposure or evidence of ongoing TB transmission, health care personnel without latent TB infection should not have routine serial TB screening or testing at any interval after baseline.

Facilities still have room to decide. The report says facilities might consider serial screening for certain groups at higher job risk, such as pulmonologists or respiratory therapists, or in settings where transmission has happened before, such as emergency departments.

Some facilities still ask for a TB test every year. That is the facility's own policy, not a CDC recommendation for all staff. If your contract requires it, follow the contract.

What CDC does recommend every year is TB education for all health care personnel, including information about TB exposure risks.

What to keep in the worker's file

A clean TB file makes it easy to show a facility that the worker meets both CDC's recommendations and the facility's contract.

• Baseline risk assessment and symptom evaluation, with dates.
• Baseline test type (blood test or skin test), dates, and results. For a skin test baseline, both steps.
• For prior positives: the documented prior result and the chest x-ray report.
• Any latent TB treatment records, or yearly symptom evaluations if treatment was not completed.
• Post-exposure symptom checks and test results, if any.
• Date of the most recent annual TB education.
• Any extra testing the facility contract requires.

Common questions

Sources

• CDC MMWR: TB Screening, Testing, and Treatment of U.S. Health Care Personnel, 2019 (68[19]:439-443)
• CDC: Baseline Tuberculosis Screening and Testing for Health Care Personnel
• CDC MMWR: Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings, 2005 (54[RR-17])