Frequently Asked Questions on Requirements for Tuberculosis Testing Under the Aerosol Transmissible Disease Standard
(Title 8 Section 5199)

February 27, 2023

Revisions and updates can be found at the bottom of this page.

  1. How should an employer determine which employees have “occupational exposure” to aerosol transmissible pathogens and aerosol transmissible pathogens-laboratory as defined in the Aerosol Transmissible Disease Standard (title section 5199) and therefore fall under the requirement that assessment for latent tuberculosis (TB) infection and TB testing be made available at least annually?
    • Are physicians, nurses, physical therapists, phlebotomists, and others who provide patient care to individuals assumed to have occupational exposure to aerosol transmissible diseases such as TB?
      • Yes
    • Are clerical workers or other non-clinical support staff who work in patient care areas at risk for aerosol transmissible diseases such as TB?
      • Yes
    • Are researchers or laboratorians (who do not work with TB bacteria) who work in laboratories separate from patient care areas at risk for aerosol transmissible diseases such as TB?
      • Employees who work in laboratory areas in which aerosol transmissible pathogens – laboratory are handled or reasonably anticipated to be present are covered by the requirement for initial and annual TB assessment and testing.
      • There is a limited exception to the requirement in section 5199(h)(3) only for “Research and production laboratories in which M. tuberculosis containing materials are not reasonably anticipated to be present, need not provide assessment for LTBI infection.”
    • Are non-clinical staff such as administrators, mechanics, contractors, and others who do not work in patient care areas at risk for aerosol transmissible diseases such as TB?
      • Yes. In non-health care situations, such as correctional facilities and facilities that house inmates or detainees, certain drug treatment programs, and homeless shelters, it is likely that these employees have occupational exposure, even though they do not work in patient care areas.
      • Yes. In health care or public health, administrators, mechanics, and others who do not work in patient care areas may have occupational exposure, for example administrative people working in admitting or the emergency department, or in laboratories.
      • Yes. Mechanics or contractors that service ventilation systems or other equipment reasonably anticipated to contain aerosol transmitted pathogens or aerosol transmitted pathogens-laboratory likely have occupational exposures and are specifically covered by the ATD Standard.
      • No. Employees who are not in areas where patients, clients, residents, inmates, etc. are present and do not have occupational exposures as defined by section 5199 likely do not have elevated risk of contracting an aerosol transmissible disease compared to employees with public contact in facilities, service categories, or operations not covered by section 5199.
  2. What does it mean to “provide” and “make available” annual TB testing to employees deemed to have occupational exposure to aerosol transmissible diseases such as TB?
    • Does hanging posters in common areas within employee work areas alerting them to availability of TB testing at specific places and times meet the standard?
      • Posters alone are not sufficient. Posters can be part of method of alerting employees to the availability of TB testing combined with other measures such as emails, letters, etc. to the affected employee. Training on the employer’s TB surveillance procedures is also required.
    • Does sending group or individual emails to staff alerting them to availability of TB testing at specific places or times meet the standard?
      • Yes, if the testing is made available at reasonable times and places for employees on employees’ paid time and this information is communicated to employees. Employees not available at the specific times and places must be offered reasonable alternative times and places for testing. Training on the employer’s TB surveillance procedures is also required.
    • Are letters sent to employees alerting them to availability of TB testing at specific times or places sufficient to meet the standard?
      • Yes, if the testing is made available at reasonable times and places for employees on employees’ paid time and this information is communicated to employees. Employees not available at the specific times and places must be offered reasonable alternative times and places for testing. Training on the employer’s TB surveillance procedures is also required.
    • Are reminders to staff of TB testing availability through annual TB education (regarding TB risk factors, risk of TB infection progressing to TB disease, and signs and symptoms of TB disease) sufficient to meet the standard?
      • Training on the employer’s TB surveillance procedures is required. However, an oral communications and training alone are not sufficient. Oral communications and training can be part of method of alerting employees to the availability of TB testing combined with other measures such as emails, letters, etc. to the affected employee.
    • Are employers required to have employees sign a declination statement if they elect to not receive a TB test?
  • February 27, 2023
    • Page created.