A newly hired employee reports a history of active tuberculosis and has completed therapy. What action should be taken first?

• A. Initiate airborne isolation precautions for the employee.
• B. Perform an individual risk assessment and symptom screening.
• C. Begin routine TB prophylaxis for all new hires.
• D. Order a full TB panel including IGRA for all new hires.

Answer: (B)

The main idea is to determine current infectious status before taking any action. For someone with a history of active tuberculosis who has completed treatment, the first step is to perform an individual risk assessment and symptom screening. This means asking about current TB-related symptoms (such as a persistent cough, fever, night sweats, weight loss, or hemoptysis), recent exposures, and reviewing their medical history and documentation of treatment completion. If they are asymptomatic and there’s clear documentation that active TB treatment was completed, they are not contagious and do not require airborne isolation or routine prophylaxis.

If the assessment raises concern for possible active TB (for example, new symptoms or signs suggesting relapse), then further diagnostic workup is warranted (such as chest imaging or microbiologic testing) to guide any needed isolation or treatment. Routine prophylaxis for all new hires or ordering broad panels on every hire isn’t appropriate without symptoms or risk signals. The goal is to verify infectious status safely and efficiently before applying any infection control measures.