Fwd: [MCOH-EH] when to repeat 2-step TB skin testing

Cunha, Bruce cunha.bruce at marshfieldclinic.org
Wed Jul 2 06:58:00 PDT 2008


HI Caroline

CDC's guidelines (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5417a1.htm)  Page 29, box #1 has a good list of incidations for two-step skin test.  This talks about new hires.

In the frequently asked questions, Page 83, the question is asked if a Two-step is needed for an employee that did not have a TST in the last 18 months.  Answer is No, two-step is only needed to establish a baseline.

We have switched to QuantiFERON Gold for all TB testing.  This has significantly decreased our number of positive employees.  We also are following the CDC guidelines and due to our low TB patient population, have eliminated annual TB testing for the majority of our employees.  In our 14 years of screening all employees (7,000+) we did not have a single conversion that we could trace back to any active TB patient that we saw.

Our State has been encouraging the use of the QFG test as they cover the cost of treating latent TB.  The number of Latent TB cases diagnosed by TST is much higher than the actual QFG positives.    So, use of QFG will save money and also save employees/patients from having to take medications that are not needed. 


Bruce E. Cunha RN MS COHN-S
Manager, Employee Health and Safety
Marshfield Clinic
Marshfield WI.

There is a misleading, unwritten rule that states if a quote giving advice comes from someone famous, very old, or Greek, then it must be good advice. -Bo Bennett

------Original Message------
From:	"Caroline.Guenette at uchospitals.edu" <Caroline.Guenette at uchospitals.edu>
Date:	Wed Jul 02, 2008 -- 08:30:23 AM
To:	mcoh-eh at mylist.net
Subject:	[MCOH-EH] when to repeat 2-step TB skin testing

Like most medical centers we perform 2-step TB screening for new employees followed by annual TB testing.  We have employees who return for their "annual" ppd but it may have been anywhere from 13 months to two (or more) years since their last ppd.  Some in our group believe that a 2-step needs to be repeated if it has been greater than 12 months since the last TB skin test (regardless of whether the last ppd was an annual (periodic) ppd or 2nd step of a 2-step ppd).   If a two-step was performed initially (and was negative) and the employee has had periodic ppds I would think the chance of a boosted reaction on a second 2-step would be slim to none.  I'm not sure what the cut off should be for repeating a 2-step on a current employee - repeat if it has been greater than 2 years, 5 years, 10 years since their last ppd?  What do other facilities do?  I know that using Quantiferon TB-Gold would solve this issue but we are currently only able to do this test on selected employees.  We hope to make it hospital-wide soon.  Thank you.

 

Caroline Guenette, MS, APNC
University of Chicago Medical Center



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