TB Tests, Immunizations, and Health Requirements for CNA Clinicals in Washington

Washington's nursing assistant rule, WAC 246-841A-440, requires 40 of your 108 training hours to be spent in a licensed nursing facility, and it is the facility, not the state, that sets the health requirements for anyone working on its floor. In practice that means a negative tuberculosis (TB) screen and proof of specific immunizations before your first clinical day. Neither the Washington State Board of Nursing (WABON) nor the Department of Health (DOH) publishes a student immunization list; the requirements come from the facility's infection-control policy, which your program passes on to you at enrollment. This guide explains what is typically required, why, and how to complete it in time for a 4-week course.

Who sets CNA clinical health requirements in Washington

Three layers of rules apply, and only one of them names specific tests:

Because the facility holds the final say, two Washington programs can ask for slightly different paperwork. Gathering the full set described below covers what most skilled nursing facilities in King and Pierce counties request.

TB screening: what the CDC recommends and what facilities ask for

The 2019 recommendations from the CDC and the National Tuberculosis Controllers Association describe baseline TB screening for health care personnel as three parts: an individual risk assessment, a symptom evaluation, and a test, either a tuberculin skin test (TST) or a blood test (interferon-gamma release assay, IGRA). Nursing facilities usually apply the same baseline standard to students because students perform the same resident contact as staff.

What you can expect to be asked for:

• A two-step TST (two skin tests placed one to three weeks apart, each read 48 to 72 hours after placement), or
• A single IGRA blood test (sold under brand names such as QuantiFERON or T-SPOT), which replaces the two-step process with one draw, or
• Documentation of a prior positive test plus a chest x-ray showing no active disease, with a symptom screen, for people who have previously tested positive or received the BCG vaccine.

The CDC's 2019 guidance also states that health care personnel without latent TB infection should not undergo routine annual retesting unless there is a known exposure. Facilities still commonly require the screen to be dated within the last 12 months, so a test from two years ago will not satisfy most sites.

Decision rule for the type of test

Choose the IGRA blood test if you were born in, or lived for a long period in, a country where the BCG vaccine is given, because BCG can cause a false positive on the skin test but does not affect the IGRA. Choose the IGRA also if you cannot make the four clinic visits a two-step TST requires. Choose the two-step TST if cost is the deciding factor and you have no BCG history; the skin test is typically cheaper at public health clinics and pharmacies.

Immunization records nursing facilities commonly require

The following list reflects what licensed nursing facilities in Washington commonly request from clinical students; it matches the CDC's adult health care personnel recommendations, and your program will tell you which items its facility requires.

If you have no childhood record, a titer panel from a clinic answers MMR, varicella, and hepatitis B in a single blood draw, which is often faster than restarting vaccine series.

Timeline for a 4-week program

The 108-hour program at Huduma CNA Programs runs 35 theory and 33 skills-lab hours before the 40 clinical hours, so clinical days start in the second half of the course. Work backward from that:

1. At enrollment (3 to 4 weeks before class): Get the facility's health requirement list from the program. Book a TB appointment the same week.
2. Week 1 of class or earlier: Complete the first TST placement, or the IGRA draw. Request any missing immunization records from your school, prior employer, or the Washington Immunization Information System through a clinic.
3. Week 2: Second TST placement and reading, if using the skin test. Submit all records to the program.
4. Before clinical day 1: The program confirms your file is complete. Students with incomplete health files cannot enter the facility, which delays the clinical hours and, therefore, the Certificate of Completion.

A two-step TST needs a minimum of about three weeks from first placement to final reading, which is why booking it at enrollment matters more than any other item on the list.

Where to get tested in South King County

You do not need a primary care doctor for most of these items. Retail pharmacy clinics, urgent care centers, community health centers with sliding-scale fees, and public health clinics in King County typically offer TB tests and adult vaccines, and employer occupational health departments handle them for students already working in health care. Costs vary by site and insurance; a TST is generally the cheapest option and an IGRA the most expensive.

Bring photo identification and prior records to each appointment, and ask for a printed copy of the result on the day; some programs will not accept a screenshot from a patient portal.

Health requirements and the HCA-CNA bridge

Students entering the 40-hour HCA-CNA bridge at Huduma CNA Programs still complete 6 clinical hours in a facility, so the same TB and immunization rules apply. Home Care Aides who work for an agency or adult family home often already have a TB result on file with their employer; ask your employer for a copy before paying for a new test. If your last screen is older than 12 months, plan on a new one. Details on bridge structure are in the HCA to CNA bridge program in Washington.

What happens if a test comes back positive

A positive TST or IGRA does not by itself bar you from clinicals. Under the CDC's guidance, a newly positive result leads to a symptom evaluation and a chest x-ray to rule out active TB disease. A clear x-ray plus documentation from the clinician generally satisfies facilities, and you may be offered treatment for latent infection, which is a separate decision to make with your clinician. Tell your program as soon as you know, because the x-ray adds several days to your timeline.

Background check versus health screening

Two separate clearances happen before clinical placement. The name-based background check concerns criminal history and is described in the Washington CNA background check; the health screen concerns infection control and is set by the facility. Huduma CNA Programs requires both before a student enters the nursing home. A full list of enrollment paperwork is in documents you need to enroll in a Washington CNA program.

Frequently asked questions

Does Washington law require a TB test for CNA students? The training rule, WAC 246-841A-440, does not list health tests. The licensed nursing facility that hosts your 40 clinical hours requires them under its own infection-control policy.

Can I use a TB test from my current job? Usually yes, if it is dated within the last 12 months and the result is documented on clinic letterhead. Confirm with your program, which checks it against the facility's rule.

I had the BCG vaccine as a child. Which test should I get? Ask for the IGRA blood test. BCG can produce a false positive on the skin test, and an IGRA avoids that problem.

Do I have to get the hepatitis B series? Most facilities accept a signed declination for students, but some employers later require the series. Starting it during training saves time when you apply for jobs.

What if my records are in another language? Facilities generally accept translated records or, more simply, a titer panel showing immunity, which sidesteps the translation question.

Will Huduma CNA Programs tell me exactly what to bring? Yes. The facility's list is provided at enrollment, and health items must be complete before the clinical portion of the CNA Traditional program.

For the full picture of what clinical days involve once your file is cleared, read CNA clinical rotations in Washington, and check upcoming start dates on the class schedule so you can book your TB test early enough.