TB Test Ethics and Regulations 2 — Questions and Answers
Question 1: Under HIPAA, which of the following is a permissible disclosure of a patient's positive TB test result without written authorization?
- Sharing with the patient's employer for insurance purposes
- Reporting to the state or local public health department (Correct answer)
- Disclosing to the patient's family members upon their request
- Posting results in the clinic's shared records system
Correct answer: Reporting to the state or local public health department
HIPAA permits disclosure to public health authorities for disease surveillance and control activities, including mandatory TB reporting.
Question 2: A TST reader notes that a patient's induration measures 11 mm. The patient is an otherwise healthy adult with no known risk factors. What is the correct ethical next step?
- Report the result as negative to avoid unnecessary patient anxiety
- Document and report the accurate measurement regardless of personal interpretation (Correct answer)
- Round down to 10 mm to align with standard risk thresholds
- Defer to a physician to re-read the test before documenting
Correct answer: Document and report the accurate measurement regardless of personal interpretation
Healthcare professionals have an ethical and legal obligation to document accurate measurements; falsifying or altering results is misconduct.
Question 3: Which federal agency primarily oversees workplace TB testing requirements for healthcare workers in the United States?
- Centers for Disease Control and Prevention (CDC)
- Food and Drug Administration (FDA)
- Occupational Safety and Health Administration (OSHA) (Correct answer)
- Health Resources and Services Administration (HRSA)
Correct answer: Occupational Safety and Health Administration (OSHA)
OSHA enforces workplace safety regulations, including bloodborne pathogen and TB exposure control standards for healthcare employees.
Question 4: A patient refuses a TB test required for employment in a healthcare facility. How should the healthcare provider respond?
- Administer the test without consent to protect public safety
- Document the refusal, inform the patient of potential employment consequences, and respect the decision (Correct answer)
- Contact the employer immediately and recommend termination
- Administer a blood-based IGRA test instead without explaining the change
Correct answer: Document the refusal, inform the patient of potential employment consequences, and respect the decision
Patient autonomy must be respected; providers should document refusal, counsel on consequences, but not force testing.
Question 5: Which of the following best describes the concept of 'duty to warn' in the context of active TB disease?
- The obligation to notify all individuals a TB-positive patient has ever met
- The legal and ethical responsibility to report active TB to public health authorities to protect the community (Correct answer)
- The requirement to post a public notice at the patient's workplace
- The obligation to warn only the patient's immediate household members
Correct answer: The legal and ethical responsibility to report active TB to public health authorities to protect the community
Duty to warn in TB cases is fulfilled by mandatory reporting to public health authorities, who then conduct contact investigations.
Question 6: A TB test administrator realizes they placed a TST intradermally on the wrong arm after the patient left. What is the appropriate action?
- Document the error in the patient record, notify a supervisor, and contact the patient to arrange correct follow-up (Correct answer)
- Wait to see if the result is readable before disclosing the error
- Administer a second TST immediately on the correct arm without informing anyone
- Discard the record and reschedule without documentation
Correct answer: Document the error in the patient record, notify a supervisor, and contact the patient to arrange correct follow-up
Transparency about errors, proper documentation, and corrective follow-up are ethical and regulatory requirements for healthcare professionals.
Question 7: Under CDC guidelines, which group requires a two-step TST baseline when starting employment in a healthcare setting?
- All new employees under age 30
- Adults who have not had a documented TST within the past 12 months (Correct answer)
- Any employee with a prior BCG vaccination history
- Only employees who work in high-risk TB wards
Correct answer: Adults who have not had a documented TST within the past 12 months
CDC recommends two-step baseline TST for new healthcare workers who lack documented testing within the prior 12 months to detect boosting effect.
TB Test Ethics and Regulations 2
Under HIPAA, which of the following is a permissible disclosure of a patient's positive TB test result without written authorization?