After confirming TB exposure among ED staff, what should the infection preventionist do next?

• A. Administer the tuberculin skin test and repeat it in 12 weeks.
• B. Place all exposed staff on TB treatment for 6 months.
• C. Exclude all exposed employees from work for 3 months.
• D. Notify the press to inform about the exposures.

Answer: (A)

When TB exposure occurs in a healthcare setting, the immediate priority is to identify who has been infected and who hasn’t, using a testing plan that accounts for the TB incubation window. The tuberculin skin test (or an equivalent test) should be done now to establish a baseline status for exposed staff, and then repeated about 8–12 weeks after the last exposure to detect any new infection that could have occurred during the window period. This approach allows those who have become infected to be evaluated for latent TB infection and treated if appropriate, while avoiding unnecessary treatment for those not infected and without imposing blanket work restrictions or sensationalizing the event. Because the test can be negative soon after exposure, repeating it in 12 weeks is essential.