[MCOH-EH] treatment for LTBI

[Hudson, T. Warner]

Bill - We send onboarding discovered LTBI cases to PMD with letter advising LTBI Rx but follow through is poor.  UCLA is a high risk TB health system so be sure to address those to.  In case of conversion in CA work comp in healthcare personnel it is presumed due to work unless we have great evidence to contrary so usually WC covers LTBI Rx in case of conversion.

Best,

Warner

T. Warner Hudson, MD FACOEM, FAAFP
Medical Director, Occupational and Employee Health
UCLA Health System and Campus
Office 310.825.9146
Fax 310.206.4585
Pager 800.233.7231  ID 27132
E-mail twhudson at mednet.ucla.edu<mailto:twhudson at mednet.ucla.edu>
Website www.ohs.uclahealth.org<http://www.ohs.uclahealth.org>

From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Buchta, William G., M.D.
Sent: Friday, February 26, 2016 12:25 PM
To: 'mcoh-eh at mylist.net'
Subject: [MCOH-EH] treatment for LTBI

In the context of following the CDC Guidelines on testing HCWs for TB, we are usually focus on what tests to use and how.  Beyond that issue remains the question of whether we should be testing so many employees in a low-prevalence population.  I am on a CDC/NTCA task force to look into the issue of narrowing the risk group recommended to test, which is going slowly but in the right direction.
The issue I would like to address regards how medical center OH programs deal with newly discovered or previously untreated case of LTBI in course of preplacement, periodic or post-exposure testing.  I heard an ID doc at the most recent NECOEM meeting quote the adage:  A decision to test is a decision to treat.  In cases of post-exposure LTBI and those determined to be work-related during periodic testing (lacking any other explanation), even though work comp will typically not cover prophylactic treatment without overt disease, the OH program should bear responsibility for treatment and monitoring that treatment. The OH program may choose to subcontract that service, but it probably should pay for it if the employee is willing to take prophylaxis.  However, in the case of new employees, there is less of an ethical imperative for the new employer to assume responsibility for treatment, although a case could be made for protecting co-workers and patients from subsequent active disease.
So, I would like to poll the membership about current practices.   Please go to Survey Monkey and answer 6 simple questions.   https://www.surveymonkey.com/r/9X7PF25    I will keep the poll open for about 2 weeks and post the results.  Thanks!

William G. Buchta, MD, MS, MPH
Assistant Professor, Mayo Clinic College of Medicine
Mayo Clinic, Division of Preventive, Occupational, and Aerospace Medicine
200 First St,SW,Rochester, MN 55905
Phone: 507-266-0354 Fax: 507-284-4251
Mayo Clinic, a mission-driven worldwide leader in health care for 150 years
http://150years.mayoclinic.org<http://150years.mayoclinic.org/>

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