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EROIGSA-15-0007 (PDA) approved method, Detainees who have symptoms suggestive of TB disease will be immediately placed, in an airborne infection isolationn room and promptly evaluated for suspected TB disease. Detainees who are initially tested using a test for TB infection [TB skin test (TST) or interferon gamma release assay (IGRA)] and result with a TST interpretation or IGRA positive for TB infection and no symptoms suggestive of TB disease must be evaluated with a chest radiograph within 5 days after the TST is interpreted or IGRA result is received, Detainees who are identified with confirmed or suspected active TB (e.g,, symptoms suggestive of TB or chest radiograph suggestive of TB) will be placed in a functional airborne infection isolation room and managed in accordance with the PBNDS and all applicable CDC guidelines, http://www.cdc.govltb/inviblieations/ uidelines/default.htrn. It is not necessary to house detainees separately from the general population unless there is clinical or radiographic evidence suggestive of TB disease. If chest x-rays are performed on-site, they will be performed by a trained and qualified health care provider and interpreted by a credentialed, radiologist, There will be a non -punitive process in place for detainees who refuse the screening assessment for TB. The Service Provider will notify IHSC andthe local health dep,, tment of all detainees with confirmed or suspected TB disease, including detainees with clinical or radiographic evidence suggestive of TB. Notification shall occur within one working day of identifying a detainee with confirmed or suspected TB disease. Notification to local health departments shall identify the detainee as being in ICL! custody and shall include die alien number with other identifying information. For detainees with confirmed or suspected TB disease, the Service Provider will coordinate with IHSC and the local health department prior to release to facilitate release planning and referrals for continuity of care. The service provider will evaluate detainees annually for symptoms, consistent with TB, within one year of the previously documented'113 evaluation. For detainees initially screened with a TST or IGRA with a negative result, annual evaluation will include testing with the same method as previously used. For detainees initially evaluated with a chest radiograph interpreted as not suggestive of TB disease, routine annual chest radiograph is not recommended. R, Radiology Service Provider If the service provider utilizes tele -radiology for Tuberculosis screening, the requirQmeut should be built into the established bed day rate for this IDSA. Airborne precautions In order to prevent the spread of airborne infectious disease or cross contamination of zones within the facility, it is preferred that the HVAC system in the intake screening area will be designed to exhaust to the exterior and prevent air exchange between the I 25G-14