If you work in healthcare, you need a TB test when you start your job, but annual testing is no longer required in most cases. The CDC changed the rules in 2019. Now, routine yearly TB tests are not needed unless there’s a known exposure or ongoing TB spread at your workplace.
This guide explains everything about TB testing for healthcare jobs. You’ll learn when testing is required, what types of tests are available, and how to stay up to date with health rules. We’ll cover the 2019 changes, special state rules, and what happens if you test positive.
What Changed in 2019?
The rules for TB testing in healthcare changed a lot in 2019.
The Old Way
Before 2019, most healthcare workers got TB tests every single year. It didn’t matter if you worked in a busy emergency room or a quiet office. Everyone got tested.
The New Way
The CDC updated their guidelines in May 2019 and said that routine annual TB testing is not recommended unless there is a known exposure or ongoing transmission at a healthcare facility. This was a big change.
Why did they change it? TB rates in the United States have stayed very low. In 2024, only 3.0 cases per 100,000 people were reported. Healthcare workers were getting tested over and over when their risk was actually very small.
The new rules focus on smart testing instead of blanket testing. You get tested when you start work, and then only if something specific happens.
When You Need TB Testing Now
Starting a New Job
All U.S. health care personnel should be screened for tuberculosis (TB) upon hire, before starting work. This is called baseline testing.
Your baseline screening includes three parts:
- Risk assessment – Questions about your TB exposure history
- Symptom check – Questions about cough, fever, weight loss, or night sweats
- TB test – Either a skin test or blood test
You cannot skip this step. Every healthcare worker needs baseline testing, no matter what job you’re doing.
After You’re Hired
Here’s the good news: U.S. health care personnel without latent TB infection should not undergo routine serial TB screening or testing at any interval after baseline.
This means once you pass your baseline test, you’re done with routine testing.
When Annual Testing Still Happens
Some workplaces and situations still need yearly testing:
High-risk jobs – For employees in high-risk settings, such as respiratory therapists or pulmonologists, annual tuberculosis screening can be considered.
High-risk areas – Places where TB happened before, like some emergency departments
State rules – California requires TB tests and other forms of TB assessment to be provided at least annually for many healthcare workers, even though federal CDC guidelines don’t require it
Your workplace policy – Some hospitals choose to test more often
Known Exposure
All health care personnel with a known exposure to TB disease should receive a TB symptom screen and testing.
If someone with active TB comes to your workplace, you need:
- Immediate testing
- Another test 8 to 10 weeks later
This happens even if your last test was recent.
Changing Jobs
When you switch healthcare jobs, the new employer will probably want baseline testing. They need to know your TB status before you start work.
Understanding TB Test Types
There are two main types of TB tests. Both work well, but they work differently.
Skin Test (PPD or TST)
The skin test has been around for many years. It’s also called the tuberculin skin test or PPD test.
How it works:
A nurse injects a tiny amount of fluid called tuberculin under your skin. A small bump appears right away. That’s normal.
You come back in 48 to 72 hours. The nurse measures any swelling or redness. The size tells them if you’ve been exposed to TB.
Pros:
- Less expensive than blood tests
- Widely available at most clinics
- Works well for most people
Cons:
- The TB skin test requires a minimum of two visits
- The TB skin test can cross-react with the common BCG vaccine, causing false-positive results
- Someone has to read the results correctly
- You can’t get it wet or scratch it
Blood Test (IGRA)
Blood tests are newer. The most common one is called QuantiFERON-TB Gold Plus.
How it works:
A nurse takes a small blood sample. The lab tests how your immune system reacts to TB proteins. Results come back in a few days.
Pros:
- The TB blood test requires only one visit and is more specific than the TB skin test, reducing false-positive results
- Unaffected by prior BCG vaccination
- More accurate overall
- This test is over 97% accurate at detecting a TB infection
Cons:
- Costs more than skin tests
- Not every clinic offers it
- Still needs chest X-ray if positive
Which One Should You Get?
TB blood tests are the preferred TB test for people who have received the Bacille Calmette-Guérin (BCG) vaccine. This vaccine is common in countries outside the U.S.
If you got the BCG vaccine as a child, always choose the blood test. The skin test might give you a false positive result.
For everyone else, both tests work fine. Ask your employer which one they prefer or schedule a TB test at a local clinic.
Two-Step Testing for Skin Tests
If you’re getting a skin test for the first time as a healthcare worker, you might need two tests.
Why Two Tests?
Two-step testing is recommended for the initial TB skin test for adults who may be tested periodically, such as health care personnel.
Here’s what happens: Some people had TB exposure years ago. Their first skin test might be negative. But the test “wakes up” their immune system. A second test 1 to 3 weeks later might then be positive.
Two-step testing helps tell the difference between:
- Old TB infection (already there)
- New TB infection (just happened)
How It Works
Week 1: Get your first skin test. Come back in 48-72 hours for reading.
If negative: Get a second test 1-3 weeks later. Come back again in 48-72 hours.
Both negative? You’re clear. Future tests can be one-step.
Second one positive? This shows old exposure, not new infection.
Blood tests don’t need two-step testing. That’s another reason many places prefer them.
State Rules Can Be Different
The CDC sets national guidelines, but states can make their own rules.
California’s Strict Rules
California has some of the toughest TB testing rules in the country. TB tests and other forms of TB assessment shall be provided at least annually in many California healthcare settings.
This means:
- You get tested when hired
- You get tested every year after that
- No exceptions for low-risk workers
Other States
Most states follow CDC guidelines now. A few still require yearly testing. Check with your:
- State health department
- Employer’s human resources team
- Professional licensing board
What Happens If You Test Positive
A positive TB test doesn’t mean you’re sick. Let’s break this down.
Latent TB vs. Active TB
Latent TB means you have TB bacteria in your body, but they’re sleeping. You feel fine. You can’t spread it to anyone. People with latent TB can’t spread the disease to others.
Active TB means the bacteria are growing and making you sick. You might have a bad cough, fever, night sweats, or weight loss. You can spread it to others.
Next Steps After Positive Test
All personnel with a newly positive test result should receive a symptom evaluation and chest radiograph, with followup as indicated.
Your doctor will order:
- Chest X-ray – Looks for TB in your lungs
- Symptom check – Questions about how you feel
If your chest X-ray is clear and you feel fine: You have latent TB. Treatment is recommended but not always required.
If your chest X-ray shows problems or you have symptoms: More tests are needed. You might have active TB.
Treatment Options
Treatment is strongly encouraged for health care personnel diagnosed with latent TB infection.
Modern treatment is much easier than it used to be. You don’t need 9 months of pills anymore. New treatments take just 3-4 months.
Why treat latent TB? Because it can wake up later and become active disease. Treatment stops this from happening.
Working With Positive Results
If you have latent TB and no symptoms, you can keep working. You’re not contagious.
If you have active TB, you cannot work around patients until treatment makes you non-contagious. This usually takes a few weeks of treatment.
Who Needs TB Testing in Healthcare
Not just doctors and nurses need TB tests.
Healthcare Workers Who Need Testing
TB screening programs should include anyone working or volunteering in health care settings, including:
- Doctors and nurses
- Medical assistants and techs
- Physical therapists
- Phlebotomists (people who draw blood)
- Respiratory therapists
- Emergency medical workers
- Nursing home staff
- Home health aides
- Volunteers who work with patients
- Students doing clinical rotations
Support Staff
Even people who don’t touch patients might need testing:
- Cleaning staff who work in patient areas
- Food service workers in hospitals
- Maintenance workers
- Security guards
- Office staff in clinical areas
If you share air with patients who might have TB, you probably need testing.
TB Testing at Different Healthcare Settings
Hospitals
Most hospitals follow CDC guidelines now. You get baseline testing when hired. Annual testing happens only in high-risk areas like emergency rooms or infectious disease units.
Nursing Homes
Nursing homes often still do yearly testing. Older adults have weaker immune systems, so extra caution makes sense.
Clinics and Doctor’s Offices
Small clinics usually follow CDC guidelines. Baseline testing when hired, then testing only if exposure happens.
Home Health
Home health workers get baseline testing. Some agencies test yearly because you visit many different homes.
TB Symptoms Healthcare Workers Should Know
Every healthcare worker should know TB symptoms, even without yearly testing.
Warning Signs
Watch for these symptoms lasting more than 3 weeks:
- Bad cough that won’t go away
- Coughing up blood or mucus
- Chest pain
- Unplanned weight loss
- Tiredness
- Fever
- Night sweats
- Loss of appetite
What to Do
Health care personnel should know the symptoms of TB disease that should prompt an immediate evaluation between screening.
If you have these symptoms:
- Tell your supervisor right away
- See employee health or your doctor
- Get tested, even if your last test was recent
- Stay away from patients until you’re checked
Don’t wait for your next scheduled test. These symptoms need immediate attention.
Annual TB Education Requirement
Even though annual testing isn’t required anymore, all health care personnel should receive annual TB education.
What TB Education Covers
Your workplace should teach you about:
- How TB spreads
- Who’s at risk
- TB symptoms to watch for
- Infection control at your workplace
- What to do if you’re exposed
- Treatment options for TB
This training is usually quick – maybe 30 minutes to an hour each year. It keeps TB awareness fresh in your mind.
Special Situations
If You Had TB Before
Health care personnel with a document history of a positive TB test result do not need to be re-tested after exposure to TB disease.
If you tested positive years ago:
- You don’t need more TB tests
- You get symptom checks instead
- Bring proof of your old positive test and treatment
- Tell every new employer about your history
Pregnancy
Pregnant healthcare workers can still get TB tests. Both skin and blood tests are safe during pregnancy.
If a chest X-ray is needed, your doctor will use a protective shield for your belly.
Weak Immune Systems
People with HIV, diabetes, or other conditions that weaken immunity need special attention.
Blood tests work better than skin tests for these folks. The IFN-γ–based tests are more sensitive than the tuberculin skin test in people with weak immune systems.
How Much Does TB Testing Cost
With Insurance
Most health insurance covers TB testing for work requirements. You might have a small copay.
Without Insurance
Costs vary by location:
- Skin test: Usually $20-50
- Blood test: Usually $75-150
- Chest X-ray (if needed): $100-300
Many health departments offer free or low-cost TB testing. Call your local health department to ask.
Your employer might pay for required testing. Check with human resources before paying out of pocket.
Common TB Testing Questions
How Long Are TB Test Results Good For?
Most employers accept TB test results from the past year. Some want tests done within 6 months of starting work.
State rules vary. California often wants tests within 6 months for school or healthcare jobs.
Can I Get the Same Type of Test Every Time?
For consistency, use the same type of TB test (e.g., TB blood test or TB skin test) that was used upon hire and for any follow-up testing.
If you started with a blood test, stick with blood tests. If you started with a skin test, use skin tests for follow-ups.
What If I Miss My Follow-Up Appointment?
For skin tests, you must get the test read within 48-72 hours. If you miss this window, the test is wasted. You’ll need to start over with a new test.
Set phone reminders so you don’t forget!
Can I Exercise After a TB Test?
Yes, normal activity is fine. Just don’t scratch or pick at the test site. Keep it clean and dry.
Do I Need Time Off Work for Testing?
Baseline testing takes about 30 minutes for the first visit. Skin test follow-ups take about 10 minutes.
Blood tests need just one visit – about 15 minutes total.
Most employers let you do this during work hours since it’s required.
Tips for Healthcare Workers
Keep Your Records
Save copies of:
- All TB test results
- Chest X-ray reports
- Treatment records (if you had TB)
- Vaccination records
You’ll need these for future jobs. Store them somewhere safe, like a home file or cloud storage.
Update New Employers Quickly
When you start a new healthcare job, give them your TB records right away. Don’t wait until the last minute. Processing takes time.
Know Your State’s Rules
If you work in California, New York, or a few other states, annual testing might still be required. Check state health department websites for current rules.
Watch for Workplace Exposures
If someone at your workplace gets diagnosed with active TB, speak up. Make sure employee health knows you were exposed. Get tested right away.
How Yorktown Health Can Help
Getting your TB test at Yorktown Health in Lisle is simple and fast.
We offer:
- Both skin tests and blood tests
- Same-day appointments available
- Quick result documentation
- Professional staff who handle everything correctly
- Follow-up reminders so you don’t miss readings
We understand healthcare workers have busy schedules. That’s why we make TB testing as smooth as possible.
Whether you’re starting a new job, need clearance for work physicals, or got exposed to TB, we’re here to help.
Final Thoughts
TB testing rules for healthcare workers changed a lot in 2019. The main takeaway is simple: You need testing when you start a healthcare job, but routine yearly tests are gone for most workers.
Get baseline testing when hired. Know the symptoms of TB. Get tested if you’re exposed. Follow your state’s rules if they’re stricter than CDC guidelines.
If you need a TB test for work, school, or any other reason, contact Yorktown Health today. We’ll get you tested quickly and provide the documentation you need. Our team in Lisle makes the process easy so you can focus on taking care of others.
TB testing protects you, your coworkers, and the patients you serve. Stay informed, stay tested when needed, and stay healthy.