Important question. OH does not have budget to evaluate and treat LTBI in new hires and this is a leaky area. My answers are below.
T. Warner Hudson, MD FACOEM, FAAFP
Medical Director, Occupational and Employee Health
UCLA Health
System and Campus
Pager 800.233.7231 ID 27132
I am hoping to hear from folks who work in healthcare facilities that are considered high risk for TB.
I am wondering how you manage employees with positive Skin or IGRA tests (all positives not just conversions after a specific exposure) who have received recommendations for treatment for latent
TB.
Here are my questions:
1. Do you refer employees with positive results for evaluation? Yes. Assuming CXR and TB questionnaire are both negative,
new hires at onboarding are sent with a letter to their own doctor, signed by OH and the employee with the positive TB test copy to chart, advising INH; and conversions are sent to Occupational Health internally where we cajole and get fairly good acceptance
especially with the 3 mo of weekly rifapentine plus INH DOT. Occasionally with high risk new hires we send to ID for added success as the PCPs tend not to place on INH and this has bitten UCLA once with a declined INH new hire 2007 RN who became active TB
2014 and exposure >100 employees and staff.
2. Are they required to go for eval – yes for conversions; the letter is explicit but we
are not able to check that they followed up with PCP
3. If treatment is recommended, does the employee have the option of refusing treatment? yes but must sign declination
form which is kept in chart
4. If treatment is refused by the employee, are there consequences associated with refusal? No other than the documented
refusal in the chart Consequences could include disciplinary action, removal from duty, termination or not allowing the employee to work in high risk areas.
I appreciate your time and feedback!
Thanks,
Kathy Dayvault, RN, BSN, MPH, COHN-S/CM
Manager, Occupational Health and Safety
WorksWell Onsite
Dekalb Medical 2701 North Decatur Road
Decatur, GA 30033
ph: 404.501.4972 Fax:404-501-2045
kathy.dayvault@dekalbmedical.org
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