TB Testing Requirements for Healthcare Workers: A State-by-State Guide

Healthcare workers in the United States face occupational tuberculosis (TB) exposure risks that vary by setting, patient population, and local epidemiology. TB testing requirements for healthcare workers are not uniform across the country. State regulations, facility policies, and professional guidelines each play a role in determining who gets tested, how often, and with which method. This article provides a comparative overview of TB testing mandates across states, including frequency, methods, and documentation, with a table summarizing key differences that healthcare workers can use to check their local requirements.

The scope here covers baseline pre-placement screening, periodic testing, and post-exposure follow-up for latent TB infection (LTBI) and active TB disease. The focus is on healthcare workers in hospitals, clinics, long-term care facilities, and other clinical settings. Students in health professions programs, researchers studying occupational health, and life-science professionals who work in clinical environments will find the state-by-state comparison useful for understanding what their employers and state regulators expect.

Why TB Testing Matters for Healthcare Workers

Tuberculosis remains an occupational hazard for healthcare workers worldwide. A systematic review and meta-analysis of studies from India found a pooled TB prevalence of 2391.6 cases per 100,000 healthcare workers, a figure that underscores the elevated risk in high-burden settings. The same analysis identified inadequate ventilation, insufficient personal protective equipment, and frequent exposure to multidrug-resistant TB strains as contributing factors. While the United States has a lower overall TB incidence than India, the occupational risk pattern holds. Healthcare workers in the U.S. encounter patients with active TB disease, sometimes before diagnosis, and sometimes in settings where infection control measures are incomplete.

The mechanism of occupational acquisition is well documented. Tuberculosis is an occupational risk hazard that explains 5 to 5,361 additional cases of TB per 100,000 individuals among healthcare workers relative to the general population in developing countries. For each clinical case, a number of additional infections occur that can be detected by tuberculin skin test conversion among non-BCG vaccinated healthcare workers or by interferon-gamma testing. Risk factors for healthcare worker infection include the number of TB patients examined, job characteristics and place of work, delay in diagnostic suspicion, patients with multidrug-resistant strains, limited access to appropriate ventilation systems, non-compliance with aerosol dissemination precautions, and immune suppressed or malnourished healthcare workers.

Molecular studies suggest that only 32 to 42% of TB cases among healthcare workers are related to occupational exposure. This means that community exposure accounts for a substantial share of infections. Screening programs that focus exclusively on workplace exposure will miss a meaningful portion of infections acquired outside the facility. This distinction matters for policy design. A healthcare worker who tests positive on a baseline screening may have acquired the infection in the community, not at work. The screening program still serves a purpose because it identifies individuals who could benefit from LTBI treatment and prevents future transmission to patients and colleagues.

Population-based surveillance from Scotland illustrates the importance of new entrant screening. Over a 16-year period, the mean incidence rate of tuberculosis among all healthcare workers was 15.4 per 100,000 healthcare workers. However, the incidence rate among healthcare workers born outside the UK was 164.8 per 100,000 compared with 5.0 per 100,000 UK-born healthcare workers. Fifty-seven percent of all non-UK-born healthcare workers were diagnosed within five years of their arrival in the UK. An effective new entrant occupational health screening program for latent tuberculosis infection may have prevented some of these active cases. This finding has direct relevance for U.S. facilities that employ internationally trained healthcare workers.

The Science Behind TB Testing Methods

Two main testing approaches are used to detect LTBI in healthcare workers: the tuberculin skin test (TST) and interferon-gamma release assays (IGRAs). Both tests detect immune responses to Mycobacterium tuberculosis, but they measure different biological signals. The TST measures a delayed-type hypersensitivity reaction to a purified protein derivative injected into the skin. IGRAs measure interferon-gamma release from T cells after stimulation with M. tuberculosis-specific antigens in a blood sample.

The World Health Organization guidelines for low TB burden countries state that either commercial interferon-gamma release assays or Mantoux tuberculin skin testing could be used to test for LTBI. Chest radiography should be performed before LTBI treatment to rule out active TB disease. Recommended treatment regimens for LTBI include 6 or 9 month isoniazid, 12 week rifapentine plus isoniazid, 3-4 month isoniazid plus rifampicin, or 3-4 month rifampicin alone.

The choice between TST and IGRA has practical consequences for screening programs. A systematic review of IGRA studies in healthcare workers found that among 24 cross-sectional studies in low TB incidence settings, the pooled prevalence of positive IGRA using either test was significantly lower than for a positive TST. In high-incidence settings there were no consistent differences in the prevalence of positive tests. IGRAs showed good correlation with occupational risk factors for TB exposure in low-incidence settings. Only 10 studies assessed use of IGRA for serial testing and all showed large variation in the rates of conversions and reversions, with no data suggesting that IGRAs are better at identifying the incidence of new TB infection than the TST.

The practical implication is that switching from TST to IGRA for one-time screening may result in a lower prevalence of positive tests and fewer healthcare workers who require LTBI treatment, particularly in low TB incidence settings. However, the use of IGRAs for serial testing is complicated by lack of data on optimum cut-offs for serial testing and unclear interpretation and prognosis of conversions and reversions. Facilities that use IGRAs for annual screening must decide how to handle borderline results and apparent reversions, which can create confusion for both employees and occupational health staff.

A 2019 commentary in The American Journal of Medicine posed a direct question about whether testing healthcare workers for latent tuberculosis is evidence based, bio-plausible, both, or neither. The title itself signals ongoing debate in the medical community about the value of routine serial testing in low-incidence settings. Healthcare workers and occupational health professionals should understand that the evidence base for annual testing is not as strong as the evidence base for baseline testing and post-exposure follow-up.

At a Glance: State TB Testing Requirements for Healthcare Workers

The table below summarizes TB testing requirements for healthcare workers in selected states. Requirements change over time, and facility policies may be stricter than state minimums. Healthcare workers should verify current requirements with their state health department and their employer's occupational health program.

This table provides a starting point for understanding state-level variation. The three states most frequently searched by healthcare workers are Texas, Florida, and California, and each has distinct requirements. Texas and Florida both require annual testing for healthcare workers in licensed facilities, with either TST or IGRA accepted. California takes a risk-based approach, with annual testing required only for workers in high-risk settings. California also expresses a preference for IGRA over TST, reflecting the state's low TB incidence and the desire to reduce false-positive TST results in BCG-vaccinated workers.

State-by-State Comparison: Texas, Florida, and California

Texas TB Testing Requirements for Healthcare Workers

Texas requires TB testing for healthcare workers in licensed facilities. New employees must receive a baseline test before or shortly after starting work. The state accepts both TST and IGRA for baseline and annual testing. Workers with a documented positive test result in the past do not need to repeat the test annually, but they must complete a TB symptom questionnaire. Workers with symptoms suggestive of active TB disease must be evaluated with a chest X-ray and clinical assessment.

Texas facilities must maintain records of employee TB tests. The record should include the date of the test, the type of test performed, the result, and any follow-up actions taken. Facilities that fail to maintain these records may face citations during state inspections. Healthcare workers who change employers in Texas should obtain a copy of their TB test records from their previous employer to avoid unnecessary repeat testing.

The Texas requirement applies to hospitals, nursing homes, ambulatory surgical centers, and other licensed healthcare facilities. It does not apply to healthcare workers in private physician offices that are not licensed facilities, although many private practices adopt the same standards as a matter of professional practice. Healthcare workers in Texas should confirm whether their specific employer falls under the licensing requirement.

Florida TB Testing Requirements for Healthcare Workers

Florida requires TB testing for healthcare workers in licensed facilities, including hospitals, nursing homes, and assisted living facilities. New employees must receive a baseline test. Annual testing is required for all healthcare workers in licensed facilities, regardless of their specific job duties. Both TST and IGRA are accepted. Workers with a documented positive test result must complete a TB symptom questionnaire annually instead of repeat testing.

Florida law requires that healthcare workers with a positive TB test receive a chest X-ray to rule out active TB disease. The chest X-ray must be repeated if the worker develops symptoms suggestive of TB. Facilities must maintain records of employee TB tests and make them available for inspection by the state agency that licenses the facility.

The Florida requirement is notable for its uniformity. Unlike California's risk-based approach, Florida requires annual testing for all healthcare workers in licensed facilities, including those with no direct patient contact. This approach is simpler to administer but may result in testing of workers whose occupational exposure risk is low.

California TB Testing Requirements for Healthcare Workers

California takes a risk-based approach to TB testing for healthcare workers. The California Department of Public Health requires healthcare facilities to conduct a baseline TB risk assessment for each employee. The risk assessment considers the worker's job duties, the patient population served, and the community TB incidence. Workers determined to be at low risk for TB exposure do not require routine annual testing. Workers in high-risk settings, such as emergency departments, respiratory therapy units, and facilities serving populations with high TB rates, require annual testing.

California expresses a preference for IGRA over TST for healthcare worker screening. This preference reflects the lower false-positive rate of IGRA in populations with high BCG vaccination rates and the logistical advantages of a single blood draw compared with a two-step TST. However, TST remains acceptable when IGRA is not available or when the worker prefers TST.

California facilities must document the TB risk assessment for each employee and maintain records of any testing performed. The risk assessment should be reviewed periodically and updated when job duties change or when the facility's TB risk profile changes.

Core Principles of Healthcare Worker TB Screening Programs

Effective TB screening programs for healthcare workers rest on several core principles that apply across states and facility types. These principles come from occupational health practice, infection control guidelines, and the published literature on healthcare worker TB.

The first principle is that screening programs must distinguish between LTBI and active TB disease. LTBI is characterised by the presence of immune responses to previously acquired Mycobacterium tuberculosis infection without clinical evidence of active tuberculosis. Individuals with LTBI are not infectious and do not require isolation. Active TB disease requires treatment and infection control measures to prevent transmission. A positive TST or IGRA result indicates infection, not disease. Chest radiography should be performed before LTBI treatment to rule out active TB disease.

The second principle is that screening programs must have a clear purpose. Baseline screening identifies healthcare workers who already have LTBI at the time of hire. This information serves two functions. It identifies workers who may benefit from LTBI treatment, and it establishes a baseline for interpreting future test conversions. Without a baseline test, a positive test later in employment cannot be distinguished from a new infection acquired at work. This distinction matters for workers' compensation claims and for epidemiologic tracking of occupational transmission.

The third principle is that screening programs must be linked to follow-up care. A positive screening test is the beginning of a clinical pathway, not the end. The worker needs a medical evaluation to rule out active TB disease, a discussion of treatment options for LTBI, and a plan for monitoring. Screening programs that identify positive tests but do not ensure follow-up care provide incomplete protection for both the worker and the patients they serve.

The fourth principle is that screening programs must be evaluated periodically. The World Health Organization conditionally recommends systematic testing and treatment of LTBI in healthcare workers, according to TB epidemiology and resource availability. This conditional recommendation acknowledges that the value of screening depends on local conditions. Facilities in high-incidence areas benefit more from aggressive screening than facilities in low-incidence areas. Facilities should review their screening data periodically to determine whether their testing frequency is appropriate for their setting.

Practical Workflow for Implementing a TB Testing Program

Healthcare facilities need a practical workflow for TB testing that covers baseline screening, periodic testing, and post-exposure follow-up. The workflow below describes the steps that occupational health programs typically follow.

Step 1: Conduct a Baseline Risk Assessment

Before implementing a TB testing program, the facility should conduct a baseline risk assessment. The assessment should consider the facility's patient population, the local TB incidence, the physical layout of the facility, and the ventilation systems in patient care areas. The risk assessment determines the frequency of periodic testing and the testing method to be used.

Step 2: Establish Baseline Testing for New Employees

All new healthcare workers with patient contact should receive baseline TB testing. The test should be administered before the worker begins patient care duties, or as soon as possible after hire. Workers with a documented history of a positive TB test should complete a symptom questionnaire instead of repeat testing. The baseline test result should be recorded in the employee's occupational health record.

Step 3: Determine Periodic Testing Frequency

The frequency of periodic testing depends on the facility's risk assessment and state requirements. Facilities in high-risk settings may test annually. Facilities in low-risk settings may test less frequently or only after known exposures. State requirements may set a minimum testing frequency that the facility cannot reduce.

Step 4: Implement Post-Exposure Follow-Up

When a healthcare worker has a known exposure to a patient with active TB disease, the facility should conduct a contact investigation. The exposed worker should receive a TB test if their last test was more than a few months prior. Workers with a negative baseline test should receive a follow-up test 8 to 10 weeks after the exposure to allow time for the immune response to develop. Workers with a positive test result should be evaluated for active TB disease and offered LTBI treatment.

Step 5: Document and Track Results

The facility should maintain a database of employee TB test results. The database should include the employee's name, job classification, test date, test type, test result, and any follow-up actions. The database allows the occupational health program to identify workers who are due for periodic testing and to track conversion rates over time.

Step 6: Review and Update the Program

The facility should review its TB testing program annually. The review should examine conversion rates, the number of positive tests, the number of workers who completed LTBI treatment, and any gaps in follow-up care. The review should also consider changes in state requirements and local TB epidemiology.

Records and Measurements for TB Testing Programs

Occupational health programs should track specific measurements to evaluate the effectiveness of their TB testing program. These measurements provide data for program improvement and for compliance with state requirements.

The first measurement is the baseline positivity rate. This is the percentage of new employees who test positive for LTBI at the time of hire. A high baseline positivity rate may indicate that the facility is hiring workers from communities with high TB prevalence. A low baseline positivity rate may indicate that the facility's hiring pool has low TB risk.

The second measurement is the annual conversion rate. This is the percentage of employees with a negative baseline test who convert to a positive test during a given year. A study at a 2,700-bed tertiary hospital in Seoul found that the cumulative LTBI conversion rate between 2020 and 2024 was 5.3% among high-risk healthcare workers, with annual conversion rates ranging between 0.7% and 1.5%. Converters were significantly older than non-converters, and longer tenure was observed among converters. Facilities should track their own conversion rates and compare them with published benchmarks.

The third measurement is the exposure event rate. A retrospective cohort study of healthcare workers at a tertiary hospital found that TB exposure rates increased with higher risk classification, as did the mean number of exposure events per person. The incidence of LTBI was 1.0% overall. After adjustment, LTBI incidence was associated with two or more TB exposure events, but did not differ significantly by group classification. This finding suggests that the number of exposure events is a better predictor of LTBI risk than the worker's job classification alone.

The fourth measurement is the treatment completion rate. This is the percentage of workers with LTBI who complete a full course of preventive treatment. Low treatment completion rates indicate that the program is identifying infections but failing to prevent progression to active disease.

The fifth measurement is the active TB case rate. This is the number of healthcare workers diagnosed with active TB disease per 100,000 workers per year. This measurement captures the ultimate outcome that the screening program aims to prevent.

Common Failure Patterns in TB Testing Programs

TB testing programs for healthcare workers can fail in predictable ways. Understanding these failure patterns helps occupational health professionals design programs that avoid common pitfalls.

The first failure pattern is testing without follow-up. A facility conducts baseline and annual testing but does not ensure that workers with positive tests receive medical evaluation and LTBI treatment. This pattern wastes resources and provides false reassurance. The screening program identifies infections but does nothing to prevent progression to active disease.

The second failure pattern is relying on a single test method without considering the population. A facility in a community with high BCG vaccination rates uses TST exclusively, resulting in a high rate of false-positive results. Workers with positive TST results undergo unnecessary chest X-rays and medical evaluations. The program could reduce false positives by using IGRA instead of TST.

The third failure pattern is inconsistent documentation. A facility does not maintain complete records of employee TB tests. When a worker has a known exposure, the occupational health program cannot determine whether the worker had a prior negative test. This gap makes it impossible to distinguish a new infection from a pre-existing one.

The fourth failure pattern is ignoring the risk assessment. A facility conducts a baseline risk assessment but never updates it. The facility's patient population changes, the local TB incidence changes, or the facility adds a new high-risk service line, but the testing frequency remains the same. The program becomes misaligned with the actual risk.

The fifth failure pattern is treating all healthcare workers the same. A facility requires annual testing for all employees, including those with no patient contact and those who work in low-risk settings. This approach is simple to administer but wastes resources and may not provide additional protection. A risk-based approach that targets testing to workers with the highest exposure risk is more efficient.

The sixth failure pattern is failing to address barriers to testing. A facility requires annual testing but does not provide convenient testing times or locations. Workers delay testing, miss deadlines, or avoid testing altogether. The program's compliance rate drops, and the facility loses the ability to detect conversions in a timely manner.

Limitations of State-Level TB Testing Requirements

State-level TB testing requirements have inherent limitations that healthcare workers and facility administrators should understand. These limitations do not mean that the requirements are useless, but they do mean that the requirements should be interpreted with appropriate caution.

The first limitation is that state requirements set minimum standards, not best practices. A facility that meets the state minimum for testing frequency may still have gaps in its TB control program. The state requirement addresses testing, but it does not address ventilation, respiratory protection, or administrative controls. A comprehensive TB control program addresses all of these elements.

The second limitation is that state requirements vary in specificity. Some states specify the testing method, the frequency of testing, and the documentation required. Other states provide general guidance and leave the details to individual facilities. Healthcare workers who move between states may encounter different requirements that are not obviously comparable.

The third limitation is that state requirements may not keep pace with changes in TB epidemiology or testing technology. A state that mandated annual TST testing a decade ago may not have updated its requirements to reflect the availability of IGRA or the declining TB incidence in the state. Healthcare workers should check for updates to state requirements instead of assuming that the requirements they learned during training are still current.

The fourth limitation is that state requirements do not address the underlying question of whether serial testing is effective. The evidence base for annual testing in low-incidence settings is limited. A systematic review found no data suggesting that IGRAs are better at identifying the incidence of new TB infection than the TST. Facilities that conduct annual testing should periodically evaluate whether the testing is detecting meaningful numbers of conversions or whether the resources could be better used elsewhere.

The fifth limitation is that state requirements do not account for individual worker risk factors. A healthcare worker who was born in a high TB burden country has a different baseline risk than a worker born in the United States. State requirements that treat all workers the same do not account for these differences. Facilities should consider individual risk factors when designing screening programs, even if the state minimum does not require it.

Safety and Regulatory Context for Healthcare Worker TB Testing

TB testing for healthcare workers operates within a broader regulatory and safety context. Healthcare workers should understand this context to appreciate why testing is required and how it fits into the larger framework of occupational health protection.

The Occupational Safety and Health Administration (OSHA) does not have a specific standard for TB testing of healthcare workers. However, OSHA's general duty clause requires employers to provide a workplace free from recognized hazards. OSHA has cited healthcare facilities for inadequate TB control programs, including failure to provide TB testing to exposed workers. Healthcare facilities should ensure that their TB testing programs meet OSHA expectations, even if the state requirements are less specific.

The Centers for Disease Control and Prevention (CDC) publishes guidelines for TB control in healthcare settings. These guidelines recommend baseline testing for all healthcare workers, periodic testing based on risk assessment, and post-exposure follow-up. The CDC guidelines are not regulations, but they are widely adopted by state health departments and healthcare facilities. State requirements often reflect the CDC guidelines, with state-specific modifications.

The Americans with Disabilities Act (ADA) has implications for TB testing programs. A positive TB test result is a medical record that must be kept confidential. Employers cannot discriminate against workers based on a positive TB test result. Workers with LTBI can perform their job duties without restrictions, provided they do not have active TB disease. Workers with active TB disease may require leave from work until they are no longer infectious.

The Family and Medical Leave Act (FMLA) may apply to workers who need time off for TB treatment. Workers with LTBI who choose to undergo treatment may need time off for medical appointments. Workers with active TB disease may need extended leave for treatment and recovery. Employers should be familiar with FMLA requirements and ensure that workers are not penalized for taking medically necessary leave.

Healthcare workers who believe their employer is not providing adequate TB testing or follow-up care have several options. They can report concerns to their state health department, to OSHA, or to their facility's infection control committee. They can also request a referral to an occupational health specialist for an independent evaluation.

Professional Escalation Criteria for TB Testing Concerns

Healthcare workers should know when to escalate concerns about TB testing beyond their facility's occupational health program. The following criteria describe situations that warrant escalation to a supervisor, the infection control committee, the state health department, or an outside occupational health specialist.

Escalate to a supervisor or the occupational health program when a required TB test is not offered within the time frame specified by state requirements or facility policy. A worker who has not received a baseline test within a reasonable time after hire should raise the issue promptly. A worker who is due for annual testing and has not been contacted by the occupational health program should also raise the issue.

Escalate to the infection control committee when a known TB exposure does not result in a timely contact investigation. Workers who have been exposed to a patient with active TB disease should receive post-exposure testing. If the facility does not initiate a contact investigation within a reasonable time, the exposed worker should report the gap to the infection control committee.

Escalate to the state health department when a facility consistently fails to meet state TB testing requirements. State health departments license healthcare facilities and have the authority to investigate complaints. A worker who has documented repeated failures by the facility to provide required testing should consider filing a complaint with the state health department.

Escalate to an outside occupational health specialist when a worker has questions about the interpretation of a TB test result or the recommended follow-up. Occupational health specialists can provide an independent assessment of the worker's risk and the appropriate next steps. Workers who are uncertain about whether to undergo LTBI treatment should seek a second opinion from a specialist.

Escalate to OSHA when a facility's TB control program poses a serious safety risk. Workers who believe that inadequate TB testing, poor ventilation, or missing respiratory protection creates a recognized hazard should report the concern to OSHA. OSHA has the authority to inspect healthcare facilities and issue citations for violations of the general duty clause.

Frequently Asked Questions

What is the difference between latent TB infection and active TB disease?

Latent TB infection (LTBI) is characterised by the presence of immune responses to previously acquired Mycobacterium tuberculosis infection without clinical evidence of active tuberculosis. People with LTBI have no symptoms and cannot spread the infection to others. Active TB disease occurs when the bacteria multiply and cause symptoms such as cough, fever, night sweats, and weight loss. People with active TB disease can spread the infection to others through respiratory droplets. A positive TST or IGRA result indicates infection, not disease. Chest radiography should be performed before LTBI treatment to rule out active TB disease.

How often do healthcare workers need TB testing?

The frequency of TB testing for healthcare workers depends on state requirements, facility policy, and individual risk assessment. Some states require annual testing for all healthcare workers in licensed facilities. Other states use a risk-based approach, with annual testing required only for workers in high-risk settings. Healthcare workers should check their state requirements and their employer's policy to determine their specific testing schedule. Workers with a documented positive test result typically complete a symptom questionnaire instead of repeat testing.

What is the difference between a tuberculin skin test and an interferon-gamma release assay?

The tuberculin skin test (TST) measures a delayed-type hypersensitivity reaction to a purified protein derivative injected into the skin. The test requires two visits, one for the injection and one for reading the result 48 to 72 hours later. An interferon-gamma release assay (IGRA) measures interferon-gamma release from T cells after stimulation with M. tuberculosis-specific antigens in a blood sample. The IGRA requires a single blood draw. Either commercial IGRA or Mantoux tuberculin skin testing could be used to test for LTBI. IGRAs may result in a lower prevalence of positive tests and fewer healthcare workers who require LTBI treatment, particularly in low TB incidence settings.

Do healthcare workers with a positive TB test need treatment?

Healthcare workers with a positive TB test should receive a medical evaluation to rule out active TB disease. If active TB disease is ruled out, the worker has LTBI and may benefit from treatment. Recommended treatment regimens for LTBI include 6 or 9 month isoniazid, 12 week rifapentine plus isoniazid, 3-4 month isoniazid plus rifampicin, or 3-4 month rifampicin alone. Treatment decisions should be made by the worker and their healthcare provider, considering the worker's risk of progression to active disease and the potential side effects of treatment.

What happens after a healthcare worker is exposed to a patient with active TB?

After a known exposure to a patient with active TB disease, the facility should conduct a contact investigation. The exposed worker should receive a TB test if their last test was not recent. Workers with a negative baseline test should receive a follow-up test 8 to 10 weeks after the exposure to allow time for the immune response to develop. Workers with a positive test result should be evaluated for active TB disease and offered LTBI treatment. The facility should document the exposure and the follow-up actions taken.

Are TB testing requirements the same for all healthcare workers in a state?

TB testing requirements are not always the same for all healthcare workers in a state. Some states require annual testing for all healthcare workers in licensed facilities. Other states use a risk-based approach, with testing frequency determined by the worker's job duties, the patient population served, and the facility's TB risk assessment. Healthcare workers should confirm their specific requirements with their employer's occupational health program and their state health department.

Can a healthcare worker refuse TB testing?

Healthcare workers can refuse TB testing, but refusal may have consequences. Employers can require TB testing as a condition of employment, particularly for workers with patient contact. Refusal to comply with a required test may result in disciplinary action or reassignment to duties that do not involve patient contact. Healthcare workers who have concerns about TB testing should discuss them with their employer's occupational health program instead of simply refusing the test.

Where can healthcare workers find their state's TB testing requirements?

Healthcare workers can find their state's TB testing requirements through their state health department. Most state health departments publish TB control guidelines or regulations on their websites. Healthcare workers can also contact their employer's occupational health program, which should have a copy of the applicable requirements. Professional organizations such as the Association of Occupational Health Professionals in Healthcare may also provide guidance on state requirements.

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This article is educational and does not replace institutional policy, professional advice, or applicable safety and regulatory requirements.