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

Thrasher, Terri Terri.Thrasher at cchmc.org
Thu Aug 3 08:17:56 PDT 2017


 Videos are good



Sent from my Verizon 4G LTE smartphone


-------- Original message --------
From: Amy Behrman <behrman at mail.med.upenn.edu>
Date: 8/3/17 11:11 AM (GMT-05:00)
To: MCOH/EH <mcoh-eh at mylist.net>
Subject: Re: [MCOH-EH] TB skin test competencies [External]

Agreed - however the CDC has excellent short training videos on placing and reading TST's. We have incorporated these into our competency process.

Amy Behrman,MD
University of Pennsylvania



> On Aug 3, 2017, at 11:07 AM, Lawrence Budnick <budnicla at njms.rutgers.edu> wrote:
>
> 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://urldefense.proofpoint.com/v2/url?u=https-3A__www.cdc.gov_mmwr_pdf_rr_rr5417.pdf&d=DwICAg&c=P0c35rBvlN7D8BNx7kSJTg&r=Jmg5o1TWVLt02_ZQHrHWz9cq2GUFrnmW1sIeobramoY&m=gxsUi8L2K22TiJYpZ8tcjGKFvFhRNKXByPltnM0VDdU&s=zgCYQvAXXhUW9C5unk3Jo5dRcT09t6TlJASgY4Xaqbc&e=  . 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://urldefense.proofpoint.com/v2/url?u=https-3A__wwwn.cdc.gov_nchs_data_nhanes_2011-2D2012_manuals_TBSkinTestManual.pdf&d=DwICAg&c=P0c35rBvlN7D8BNx7kSJTg&r=Jmg5o1TWVLt02_ZQHrHWz9cq2GUFrnmW1sIeobramoY&m=gxsUi8L2K22TiJYpZ8tcjGKFvFhRNKXByPltnM0VDdU&s=tv3WFbqaUoPa-_mO0p6w3uYKJBQplqVJB0qWBuwX7ZE&e=   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://urldefense.proofpoint.com/v2/url?u=https-3A__na01.safelinks.protection.outlook.com_-3Furl-3Dwww.lifewhereyouloveit.org-26data-3D02-257C01-257Crachel.leibu-2540atlantichealth.org-257C0ecb358b047f4d82f8e108d4da6baf68-257Cf6f442bea6a04cbebc321f76a10f316b-257C1-257C0-257C636373603425760341-26sdata-3D3UXIOp55VWp6fbl7O0oeFvSM0a-252BKMBBxq6XPbHuBJeE-253D-26reserved-3D0&d=DwICAg&c=P0c35rBvlN7D8BNx7kSJTg&r=Jmg5o1TWVLt02_ZQHrHWz9cq2GUFrnmW1sIeobramoY&m=gxsUi8L2K22TiJYpZ8tcjGKFvFhRNKXByPltnM0VDdU&s=PyA7HMihOkhbsxNTr9XMp5tQHkDHHq9KmVXD5KyH0Yw&e=
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> To become a subscriber, or to change your subscription options (turn off email while you're on vacation, etc):   https://urldefense.proofpoint.com/v2/url?u=http-3A__www.mcoh-2Deh.net&d=DwICAg&c=P0c35rBvlN7D8BNx7kSJTg&r=Jmg5o1TWVLt02_ZQHrHWz9cq2GUFrnmW1sIeobramoY&m=gxsUi8L2K22TiJYpZ8tcjGKFvFhRNKXByPltnM0VDdU&s=ie5nyFDni-2zNyCARRe8al_2hO3iu1hqRVKokPul-rk&e=
> MediTrax / Occupational Health Systems, Inc. provides financial support to ensure the list remains a free resource for the occupational health community.
> ---------------------------------------
> List archives (public): https://urldefense.proofpoint.com/v2/url?u=http-3A__mylist.net_archives_mcoh-2Deh_&d=DwICAg&c=P0c35rBvlN7D8BNx7kSJTg&r=Jmg5o1TWVLt02_ZQHrHWz9cq2GUFrnmW1sIeobramoY&m=gxsUi8L2K22TiJYpZ8tcjGKFvFhRNKXByPltnM0VDdU&s=ZCXLrgWHZronc0It3GfD9yiXs2ZK7M4N9xnVHQER5xI&e=
> ---------------------------------------
> Send administrative requests to: drjoe at meditrax.com
> ---------------------------------------


---------------------------------------
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):   https://urldefense.proofpoint.com/v2/url?u=http-3A__www.mcoh-2Deh.net&d=DwICAg&c=P0c35rBvlN7D8BNx7kSJTg&r=Jmg5o1TWVLt02_ZQHrHWz9cq2GUFrnmW1sIeobramoY&m=gxsUi8L2K22TiJYpZ8tcjGKFvFhRNKXByPltnM0VDdU&s=ie5nyFDni-2zNyCARRe8al_2hO3iu1hqRVKokPul-rk&e=
MediTrax / Occupational Health Systems, Inc. provides financial support to ensure the list remains a free resource for the occupational health community.
---------------------------------------
List archives (public): https://urldefense.proofpoint.com/v2/url?u=http-3A__mylist.net_archives_mcoh-2Deh_&d=DwICAg&c=P0c35rBvlN7D8BNx7kSJTg&r=Jmg5o1TWVLt02_ZQHrHWz9cq2GUFrnmW1sIeobramoY&m=gxsUi8L2K22TiJYpZ8tcjGKFvFhRNKXByPltnM0VDdU&s=ZCXLrgWHZronc0It3GfD9yiXs2ZK7M4N9xnVHQER5xI&e=
---------------------------------------
Send administrative requests to: drjoe at meditrax.com
---------------------------------------

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