[MCOH-EH] N95 Fit Testing Process

[Tim Crump]

Thank you Dr Thanassi for sharing the article reference.  (For those who, like me, haven't seen the article, I found it at: https://www.cdc.gov/tb/publications/guidelines/pdf/cid_ciw694_full.pdf).  In my quick skimming of the article, I didn't see that they addressed in detail anything about monitoring health care workers.  Our facility is a medium risk hospital and we have been doing annual testing on all staff with direct patient contact, based on the 2005 guidelines for preventing transmission of TB in health-care settings.  Our rationale has been that this surveillance could identify if there have been breaches in our TB controls.  Do people interpret this newer article to be saying that this annual testing/surveillance is no longer necessary and recommended?  Thanks for any input, Tim

Tim Crump, MSN, FNP
Family Nurse Practitioner
Occupational Health
Healthcare Human Resources

Oregon Health & Science University
3181 SW Sam Jackson Park Rd
Mail code: UHN 89
Portland, OR 97239-3098
Department Phone: 503-494-5271
Office Phone: 503-346-1152
Fax: 503-494-4457
Email: crumpt at ohsu.edu

Tues, Thurs, Fri, 8-4:30



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-----Original Message-----
From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Thanassi, Wendy
Sent: Friday, May 19, 2017 3:33 PM
To: MCOH/EH <mcoh-eh at mylist.net>
Subject: Re: [MCOH-EH] N95 Fit Testing Process

Most facilities that went through the torture of risk-assessment found that they are low risk, and that recommendation is for No Annual Testing, but many continued to test anyway. This is understandable because the starting-stopping-starting of a practice can be more burdensome than just keeping it going. However, this has led to tremendous cost, lost work time and erroneous diagnoses for testing of a population that is 97% negative.

So hallelujah for the even-more-recent guideline: the joint CDC/ATS/IDSA December 8, 2016 that says "Stop The Madness"... I mean, it recommends No testing on the low risk-employee, defined as no known exposure, and not born in a high-risk country With a history of TST/IGRA +). Testing upon hire is still recommended.

Hopefully the HCW-specific guideline will be finished soon and will spell the recommendations out even more clearly for all of us.

Wendy Thanassi MA, MD
Chief, PAVAHCS Occupational Health
National Lead, TB testing, VHA Occupational Health

-----Original Message-----
From: MCOH-EH [mailto:mcoh-eh-bounces+wendy.thanassi=va.gov at mylist.net] On Behalf Of Boruff, Lisa J. (IHS/PHX)
Sent: Friday, May 19, 2017 3:15 PM
To: MCOH/EH
Subject: [EXTERNAL] Re: [MCOH-EH] N95 Fit Testing Process

According to the most current  CDC TB Guideline, 2005 - TST are done according to the  annual TB Risk Assessment. The IC department usually completes the annual assessment which requires gathering multiple pieces of information- it a lengthy process.  The annual risk assessment is what determines how often employees are tested for TB. 


Lisa Boruff RN, MSN, CIC
Infection Prevention and Control Specialist, Supervisor

Phoenix Indian Medical Center
4212 N 16th St.,  
Phoenix, AZ  85016
Office: 602-263-1519
Cell: 602-819-1816
Fax: 602-200-5254
lisa.boruff at ihs.gov




-----Original Message-----
From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Thanassi, Wendy
Sent: Friday, May 19, 2017 2:55 PM
To: MCOH/EH <mcoh-eh at mylist.net>
Subject: Re: [MCOH-EH] N95 Fit Testing Process

Nursing competencies are often done on an annual basis so it can be a successful strategy to align OH exams like Fit testing with competencies. 

That said, the American Thoracic Society, the Infectious Disease Society of the Americas AND the CDC AGREE that TB testing should not be done on an annual basis... only with known exposure to active TB. (just my TB 2c :) )

Wendy Thanassi MA, MD
Chief, OH 
Palo Alto VAHCS
Sunny California

-----Original Message-----
From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Leibu, Rachel
Sent: Friday, May 19, 2017 2:49 PM
To: MCOH/EH
Subject: [EXTERNAL] Re: [MCOH-EH] N95 Fit Testing Process

It is not a good idea to do TST testing if all employees at the same time- you reduce the ability for early identification of  unknown TB exposures.

Sent from my iPhone

On May 19, 2017, at 4:18 PM, Rainey, Richard <rrainey at tgh.org<mailto:rrainey at tgh.org>> wrote:

Hi Amy!  Happy Friday!

In my previous organization, Lee Health (formerly Lee Memorial Health System), they had a staff nurse on each floor complete TB and FIT testing requirements every year for their unit.  It also had its pros and cons but  it seemed to work well.

TGH has had some thought around making Annual evals at the same time every year but no decisions have been made yet.  Our director, JoAnn Shea, had the same thought as you though to get them all done in one month.

Another way we thought of was to visit unit education blocks/staff meetings to get a good percentage of staff at one time.  TGH Education blocks are mandatory and are usually every other month for each unit so it's the perfect time to get them.

Let us know what you decide to do.  It's always interesting to find out what other organizations are doing.

Richard R. Rainey
HRIS Analyst II for
Employee Health & Wellness Services,
Workers' Compensation and Leave's/FMLA
RRainey at TGH.org<mailto:RRainey at TGH.org>
<image001.jpg>
PO Box 1289
Tampa, FL 33601
Office: 813-844-8248
Fax: 813-844-4034
TGH.org<http://TGH.org>

From: MCOH-EH [mailto:mcoh-eh-bounces+rrainey=tgh.org at mylist.net] On Behalf Of Amy Olson
Sent: Friday, May 19, 2017 3:41 PM
To: 'MCOH/EH' <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Subject: [MCOH-EH] N95 Fit Testing Process

Happy Friday,
We are moving to a new performance management system. Currently employees are evaluated in the month of their hire date. All of their annual requirements (fit testing, competencies, etc.) are to be completed prior to their review and if they are not completed the employee does not receive any increases they may be entitled to until it is completed. This has worked fairly well in ensuring people keep up on their requirements. The new system will have everyone being reviewed in the same time frame. We are looking at whether it would make sense to do the same with our fit testing. Designate a month and crank out all the fit tests and be done. Then you address new hires as they start. There are pros and cons to either method.

What are you all doing? What has worked well? Would you change? Have you recently switched to one system or the other? If so, why? Really any pearls relative to this experience would be most appreciated.

Amy Olson, BSN, MS, COHN-S
Director, Employee Health and Wellness
Johns Hopkins All Children's Hospital
500 Seventh Avenue South, Suite 103
St. Petersburg, FL  33701
P 727-767-8211 | F 727-767-8399
aolson9 at jhmi.edu<mailto:aolson9 at jhmi.edu>
www.HopkinsAllChildrens.org<https://urldefense.proofpoint.com/v2/url?u=http-3A__www.hopkinsallchildrens.org_&d=DwMFAg&c=WxSiHUljzaZa6AO7gfNF1nsjLMo-cFTcJAt_xkKy0sg&r=dAD7CPUki6cfTAjUVJ_3oA&m=qtNDfJaTlpOG3thVDtPNFOxx8KYL8LJ1eFWre1KdB-k&s=Qyixn7JwFY0AGGExQn0KBf6vtSswMZq12-jXeDwZmTs&e=>

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The MCOH-EH List is moderated by Joe Fanucchi MD FACOEM and Mike Band DO.
List membership is free, but only subscribers may post to the list.
To post send messages to: mcoh-eh at mylist.net
To become a subscriber, or to change your subscription options (turn off email while you're on vacation, etc):   http://www.mcoh-eh.net
MediTrax / Occupational Health Systems, Inc. provides financial support to ensure the list remains a free resource for the occupational health community.
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List archives (public): http://mylist.net/archives/mcoh-eh/
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Send administrative requests to: drjoe at meditrax.com
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---------------------------------------
The MCOH-EH List is moderated by Joe Fanucchi MD FACOEM and Mike Band DO.
List membership is free, but only subscribers may post to the list.
To post send messages to: mcoh-eh at mylist.net
To become a subscriber, or to change your subscription options (turn off email while you're on vacation, etc):   http://www.mcoh-eh.net
MediTrax / Occupational Health Systems, Inc. provides financial support to ensure the list remains a free resource for the occupational health community.
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List archives (public): http://mylist.net/archives/mcoh-eh/
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Send administrative requests to: drjoe at meditrax.com
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---------------------------------------
The MCOH-EH List is moderated by Joe Fanucchi MD FACOEM and Mike Band DO.
List membership is free, but only subscribers may post to the list.
To post send messages to: mcoh-eh at mylist.net
To become a subscriber, or to change your subscription options (turn off email while you're on vacation, etc):   http://www.mcoh-eh.net
MediTrax / Occupational Health Systems, Inc. provides financial support to ensure the list remains a free resource for the occupational health community.
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List archives (public): http://mylist.net/archives/mcoh-eh/
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Send administrative requests to: drjoe at meditrax.com
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