Recommendation for Tuberculosis (TB) Screening in Long-Term Care Homes and Retirement Homes

As per the Retirement Homes Act, 2010 and the Fixing Long-Term Care Act 2021: All new residents must be screened for tuberculosis within 14 days of admission unless the resident has already been screened in the 90 days prior to admission and the documented results of this screen are available to the Home.

Recommendations for Residents ≥65 years of age:

The Canadian Tuberculosis Standards, 8th edition (CTS 2022) recommends that residents of Long-Term Care Institutions or Retirement Homes undergo the following:

  • An assessment of likelihood of respiratory TB should be done on or before admission to a long-term care home or retirement home.
  • A symptom screen to rule out active TB should be done, preferably prior to, and on admission to a long-term care home or retirement home.
  • 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.
  • Routine tuberculin skin testing on (or prior to) admission and periodic tuberculin skin tests (such as annually) are not recommended for residents.
  • If a resident has had exposure to respiratory TB, the need for testing should be individualized as part of contact tracing.

Recommendations for LTCH/Retirement Home resident transfers:

Prior to transfer from another facility, a physical assessment and symptom review by a physician or Nurse Practitioner to rule out active pulmonary TB is recommended. In addition, a review of the documented TB screening previously done upon admission or a review of more recent radiology should be done. If there is any indication of possible active TB, a chest x-ray, sputum testing and any other necessary investigations should be completed to rule out active pulmonary TB disease before the transfer occurs.

Recommendations for Staff and Volunteers

Staff and volunteers at long term care homes and retirement homes should undergo baseline TB screening including:

  • An individual risk assessment that identifies their risks for TB, including temporary or permanent residence in a high-incidence country, prior TB, current or planned immune suppression or close contact with someone who has had infectious TB since the last Mantoux test (TST).
  • A symptom evaluation using the Active Tuberculosis (TB) Disease Screening for Staff and Volunteers in Long Term Care Homes and Retirement Homes form.
  • A TST for those without documented prior TB disease or latent TB infection. A TST is the preferred diagnostic test for pre-employment and periodic testing (if indicated) for latent TB infection among health care workers.

Reporting requirements for Tuberculosis:

Under the Health Promotion and Protection Act, R.S.O. 1990, c. H.7, diagnoses of TB infection (LTBI) and cases of suspect and confirmed active TB disease are reportable to Public Health. To report a case of TB infection or disease, please call the Eastern Ontario Health Unit at 613-933-1375 or 1-800-267-7120 and ask to speak to the Infectious Diseases Team.