Every finding on record at VNA Home Health Services

Based on review of Center for Disease and Control (CDC) guidelines, review of employee files (EFs), agency policies, and interview with agency Director Nursing Operations, the agency failed to ensure each new employee, office staff, and volunteers with direct patient contact, prior to patient contact, was screened for and is free from active mycobacterium Tuberculosis (TB), requiring completion of an onhire TB risk assessment questionnaire by each individual in seven (7) out of seven (7) EFs reviewed (EFs #1-7); and failed to require annual completion of TB risk assessment questionnaire (TB-RAQ) by each individual in seven (7) out of seven (7) EFs reviewed (EFs #1-7). --- Review conducted on December 2, 2024, at approximately 1:00 PM, of "Tuberculosis Screening, Testing, and Treatment of U.S. Health Care Personnel: Recommendations from the National Tuberculosis Controllers Association and CDC, 2019" revealed: "1) TB screening with an individual risk assessment and symptom evaluation at baseline (preplacement); 2) TB testing with an interferon-gamma release assay (IGRA) or a tuberculin skin test (TST) for persons without documented prior TB disease or latent TB infection (LTBI); ... 5) annual symptom screening for health care personnel with untreated LTBI; and 6) annual TB education of all health care personnel.; ... Baseline (preplacement) screening and testing. All U.S. health care personnel should have baseline TB screening, including an individual risk assessment (Box), which is neces­sary for interpreting any test result. The 2005 guidelines state that baseline test results provide a basis for comparison in the event of a potential or known exposure to M. tuberculosis, facilitate detection and treatment of LTBI or TB disease in health care personnel before placement, and reduce the risk to patients and other health care personnel (1). The risk assess­ment and symptom evaluation help guide decisions when interpreting test results."; and "*Baseline (preplacement) screening and testing, in addition to the IGRA (interferon-gamma release assay) or TST, shall include a symptom screen questionnaire and an individual TB risk assessment. Serial screening and testing not routinely recommended. Annual TB education is recommended. (CDC/MMWR/May 17, 2019/Vol. 68/No. 19). Review conducted on December 2, 2024, at approximately 1:30 PM, of employee files revealed: EF #1 date of hire (doh) 9/7/21, no onhire individual TB-RAQ, no annual individual TB-RAQ for 2022 - 2024. EF#2 doh 5/20/19 with transfer-in 11/8/20, no onhire individual TB-RAQ, no annual individual TB-RAQ for 2020 - 2024. EF#3 doh 5/25/14 with transfer in 7/19/20, no onhire individual TB-RAQ, no annual individual TB-RAQ for 2020 - 2024. EF#4 11/19/23, no onhire individual TB-RAQ, no annual individual 2024 TB-RAQ. EF#5 5/8/17 with transfer in 6/30/24, no onhire individual TB-RAQ, no annual individual TB-RAQ 2021-2024. EF#6 doh 8/7/23, no onhire individual TB-RAQ, no annual individual 2024 TB-RAQ. EF#7 doh 9/20/23, no onhire individual TB-RAQ, no annual individual 2024 TB-RAQ. Review conducted on December 4, 2024, at approximately 12:00 PM, of agency policy "Employee Health & Safety New Hire Screening" revealed: A electronic form to be completed by the potential new employee, it includes TB question "*Ever been told you have tuberculosis, had a positive test (PPD) for tuberculosis? If yes, did you have a chest x-ray? Were you treated with any medications? (INH, etc); *Had a temporary or permanent residence 1 month or more in a foreign country?; *Traveled outside of the US in the past 6 months?"; agency policy IC 206 "Prevention of Tuberculosis Transmission" revealed no requirements for onhire and annual individual TB risk assessments completion.; report "Tuberculosis (TB) risk assessment worksheet for WellSpan Facilities in Lebanon County as of December 31, 2023" revealed overall low risk for TB in the county. No requirement for onhire and annual individual TB risk assessments.; If the initial health screening questions results are marked "yes" or positive TB QuantiFERON Gold blood test is positive, a Registered Nurse reviews the individual information and requires the individual to complete the "Wellspan Employee Health & Safety Tuberculosis Surveillance Questionnaire" which includes the TB signs and symptoms questions. Interview conducted on December 3, 2024, at approximately 1:30 PM, with agency Director Nursing Operations revealed confirmation of above findings.