[MCOH-EH] TB skin test competencies [External]

Lawrence Budnick budnicla at njms.rutgers.edu
Thu Aug 3 08:07:26 PDT 2017
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We were required by our administration to allow any of our employed licensed physicians or nurses to read a TB skin test (TST), but people cannot read their own.

Since you had mentioned the CDC training, we have had some issues with the 141-page CDC 2005 Preventing TB in Health Care Facilities Guidelines https://www.cdc.gov/mmwr/pdf/rr/rr5417.pdf . For example, if you go by the CDC, which some (eg, OSHA and some ICPs) adopt as gospel (or even worse, regulatory), training could be exhaustive. On page 48, CDC describes a "Model TST Training Program." For a TB skin test placer, training should include 3 hours of lecture, 9 hours of practical work and observed administration of more than 10 skin tests. For a TST reader, training should include 6 hours of lecture and demonstration, 16 hours of practical work and at least 80 readings, with 30 "blinded independent duplicate readings." That is a total of at least 34 hours of training! In addition, CDC recommends using an observation checklist, included in the guidance as Appendix F on pages 139 and 140, with over 60 steps to plant and read a TST.  

Years ago, I called the CDC and OSHA employee health services and neither one was using the CDC's own recommended training approach. The training noted above was reportedly used as the training for NHANES staff. The current version of the NHANES training manual https://wwwn.cdc.gov/nchs/data/nhanes/2011-2012/manuals/TBSkinTestManual.pdf  does not include the observation checklist.

CDC's training recommendations are illusory and potentially harmful.

Lawrence D. Budnick, MD, MPH
Director, Occupational Medicine Service
Associate Professor of Medicine
Rutgers University - New Jersey Medical School
65 Bergen Street, Suite GA-167, Newark, NJ 07107
tel 973.972.2900
fax 973.972.2904
lawrence.budnick at rutgers.edu

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-----Original Message-----
From: MCOH-EH [mailto:mcoh-eh-bounces+budnicla=njms.rutgers.edu at mylist.net] On Behalf Of Giovannetti, Mary
Sent: Thursday, August 03, 2017 9:50 AM
To: 'MCOH/EH' <mcoh-eh at mylist.net>
Subject: Re: [MCOH-EH] TB skin test competencies [External]

We traditionally allowed anyone we trained to read. However SC DHEC recently decided that hospital employees had to be placed and read by RNs. So we had to change policy.

Mary C Giovannetti, DNP, APRN, BC-FNP
Manager/Nurse Practitioner | Employee Health



853 North Church St, Suite 400 | Spartanburg, SC 29303
o: 864-560-6514 | f: 864-560-6509
e: mgiovannetti at srhs.com | w: SpartanburgRegional.com


-----Original Message-----
From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Leibu, Rachel
Sent: Thursday, August 03, 2017 8:56 AM
To: MCOH/EH
Subject: Re: [MCOH-EH] TB skin test competencies [External]

Be aware: [This message came from outside of Spartanburg Regional Network]


Our your readers RN's and above or do you allow CMA's to read as well.

Rachel Leibu, MD, MBA, MS
Director Occupational Medicine Service
Atlantic Health System
973-971-5440

-----Original Message-----
From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Giovannetti, Mary
Sent: Thursday, August 03, 2017 8:30 AM
To: 'MCOH/EH' <mcoh-eh at mylist.net>
Subject: Re: [MCOH-EH] TB skin test competencies [External]

We do the same thing. Only staff who are specifically trained by us my read our PPDs. We have a reader form with a list of approved readers. CDC says that readers should be trained.

Mary C Giovannetti, DNP, APRN, BC-FNP
Manager/Nurse Practitioner | Employee Health



853 North Church St, Suite 400 | Spartanburg, SC 29303
o: 864-560-6514 | f: 864-560-6509
e: mgiovannetti at srhs.com | w: SpartanburgRegional.com

-----Original Message-----
From: MCOH-EH [mailto:mcoh-eh-bounces+mgiovannetti=srhs.com at mylist.net] On Behalf Of Thrasher, Terri
Sent: Wednesday, August 02, 2017 8:56 PM
To: MCOH/EH
Subject: Re: [MCOH-EH] TB skin test competencies [External]

Be aware: [This message came from outside of Spartanburg Regional Network]


I don't think it's a JCstandard but it is best practice that every nurse and MD is not allowed to read a tb skin test.   There is a skill to the reading.

-----Original Message-----
From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Angeli Mancuso
Sent: Wednesday, August 02, 2017 8:34 PM
To: MCOH/EH <mcoh-eh at mylist.net>
Subject: [MCOH-EH] TB skin test competencies

Our policy for annual (and post exposure) TB screening states that every employee able to get a TB skin test must do so at Employee Health & Safety. Reads must also occur here. Occasionally, for employees who don't plan ahead and have to get their tests read on the weekend to avoid our compliance deadline, we ask our house supervisors to read on our behalf. TB screening competency is maintained in personnel files for those authorized to perform this duty.

I get a question regarding why all nurses can't read their own or their co-workers' TB tests instead of returning to employee health. Our stance has always been that we must maintain competency in this skill just as floor nurses maintain competencies that we, as EHNs, do not maintain. I haven't given an IV push med in 8 years so I shouldn't be allowed to do so tomorrow.

Is this a policy you all maintain as well? Are we off the mark and should we consider having any RN document the result of a TB skin test? I've always been under the impression this is a Jt. Commission standard but cannot lay my hands on the exact reference.

Angeli Mancuso, RN, COHN-S/CM
Manager, Employee Health & Safety | Cottage Health P.O Box 689 | 400 W. Pueblo St | Santa Barbara, CA 93102-0689
Office: (805) 569-7866 |  Fax: (805) 569-8271 a1mancus at sbch.org | cottagehealth.org https://na01.safelinks.protection.outlook.com/?url=www.lifewhereyouloveit.org&data=02%7C01%7Crachel.leibu%40atlantichealth.org%7C0ecb358b047f4d82f8e108d4da6baf68%7Cf6f442bea6a04cbebc321f76a10f316b%7C1%7C0%7C636373603425760341&sdata=3UXIOp55VWp6fbl7O0oeFvSM0a%2BKMBBxq6XPbHuBJeE%3D&reserved=0




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