[MCOH-EH] Growing Pains for Centralized Employee Health

Kathy.Dayvault at dekalbmedical.org Kathy.Dayvault at dekalbmedical.org
Thu Jan 26 13:12:08 PST 2017

At our location, we require travelers to have an annual PPD and one within 
30 days of their start date.

Kathy Dayvault, RN, BSN, MPH
 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 at dekalbmedical.org

From:   Tara Dockery <tdockery at oceanbeachhospital.com>
To:     MCOH/EH <mcoh-eh at mylist.net>, 
Date:   01/26/2017 11:12 AM
Subject:        Re: [MCOH-EH] Growing Pains for Centralized Employee 
Sent by:        "MCOH-EH" <mcoh-eh-bounces at mylist.net>

Melanie (or anyone else with an opinion on this!),
My Epidemiologist tends to believe that because we have travelling 
Providers, or agency nurses that move around from place to place, that it 
would not make sense for them to get their PPD done at every place they go 
to. He feels (an unwritten policy should be) that they have a 2 step PPD 
on hire, then annual testing every year, unless there was an exposure, 
My issue is that the agency/contract does not have the policy that is in 
their head, so when they present to work they do not carry the 2 step from 
hire and every annual PPD since then.
I have devised that I will take one if they are recently, and if it is out 
of date I will then tell them they are due for another (and either place a 
TST or order a T-spot) and give them a copy. 
Do any of you do anything different?
Tara Lee Dockery, IP, MT(ASCP), BS
Infection Prevention and Employee Health
Ocean Beach Hospital and Clinics
174 First Avenue North
Ilwaco, Washington 98624
tdockery at oceanbeachhospital.com
Office Phone  360 – 642 - 6307 
Cell Phone 509-760-7397
Fax  360-642-6309 
From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Swift, 
Sent: Wednesday, January 25, 2017 3:41 PM
To: 'mcoh-eh at mylist.net' <mcoh-eh at mylist.net>
Subject: Re: [MCOH-EH] Growing Pains for Centralized Employee Health
First of all, don’t be discouraged that your tracking system is getting 
outdated for your growth. Our TB tracking system used to be a room full of 
index cards, one for each employee, with a series of 12 holes near the 
border representing each month. Your designated month for testing would be 
clipped out to the edge of the card. Once a month, we’d run a knitting 
needle through that month’s hole in a big stack of cards, give it a shake, 
and if your card fell to the floor it was time for your TB test! I am not 
making this up. (This was before I got here of course. I am much too young 
to even know what “index cards” are...)
Some tips on TB surveillance:
1.       Be sure you are only doing annual TB testing for locations that 
are at medium risk per the CDC 2005 guidelines. In the US, most outpatient 
clinic settings are likely to be low risk. Unless of course it’s a TB 
clinic or a special population. So do a critical check – do you really 
need annual testing at all of these off site locations?
2.       For those who need annual testing, we programmed our tracking 
system to set their next test due one year from their latest completed 
negative result. So it’s staggered throughout the year. Our system starts 
sending weekly reminder emails a month before their next service is due 
(not just TB, any test.) This is helpful because people can easily get off 
track – they have an exposure and need earlier testing, they might be out 
on leave through their normal testing month and get it when they return, 
etc. And people are hired year round.
3.       We have a designee program. We train nurses to place TSTs, and to 
read a completely normal result (if there is erythema or induration they 
must see one of our staff for a final read.) We have over 500 of these 
designee nurses scattered across the system, so each site can have several 
who can do that. Also we allow MDs and NPs to read a completely normal 
result without going through our class. Again we still insist on seeing 
any erythema or induration. We feel we cannot trust that training is good 
enough to be reliable for that. Even if everyone could accurately measure 
7mm of induration, we need to talk to the person to interpret that – are 
they immunosuppressed? Are they postexposure? Not questions a coworker 
should ask. We use REDCap for them to enter the reads, our staff review 
the data for QA purposes and enter them in our tracking system.
4.       We have an outreach nurse position - she travels to the offsites 
for everything, not just TB, and coordinates a crew of PRN nurses to 
extend our reach.
5.       To Wendy’s point, if IGRAs are dirt cheap and readily available 
where you are, you could switch to a system where employees can go to a 
lab to have it drawn with results sent to you. We aren’t able to do that 
here as it’s just too expensive. ($270 a pop, and even if we did our full 
volume the best price we could get is $50. Yes you can quote the SWITCH 
study to me until you’re blue in the face, but the “total costs” of people 
getting skin tests don’t hit my budget. Only the PPD and the syringe do!)
Hope it helps and good luck!
Melanie Swift, MD
Director, Vanderbilt Occupational Health Clinic
From: MCOH-EH [
mailto:mcoh-eh-bounces+melanie.swift=vanderbilt.edu at mylist.net] On Behalf 
Of Weaver Meredith
Sent: Wednesday, January 25, 2017 2:58 PM
To: 'mcoh-eh at mylist.net'
Subject: [MCOH-EH] Growing Pains for Centralized Employee Health
We are facing the challenges of providing employee health services to 
healthcare system that is growing a very rapid pace.  New clinics, 
off-site locations, and departments are being added monthly, if not 
weekly.  I have two questions for the group. 
1.       One of our greatest challenges is in administering our 
tuberculosis testing program.  We currently place PPDs based upon the 
designated month for the employee’s department.  It is becoming more and 
more difficult to manually update and maintain a list that is then tied to 
our electronic employee health record.  How do you administer your TB 
program? Do you designate testing by department by month, by the 
employee’s birth date, etc.?  What challenges or advantages have you seen 
with your particular program method? 
2.       If your healthcare system has gone through or is going through 
rapid growth, how have you managed providing fitness for duty testing and 
exposure management follow up to your off-site employees? Do you 
outsource, contract with other hospitals, travel, etc.? 
 / Meredith R. Weaver, SHRM-CP
Manager, Employee Health
WVU Medicine
PO Box 8120
Morgantown, WV 26506-8120
Phone: 304-598-4000 ext. 77719
Clinic: 304-598-4160
Fax: 304-598-4957
weaverm at wvumedicine.org


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