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

[Savidge, Nancy]

Same here, and far fewer false positives so there is a savings on radiology as well.

Nancy

Nancy Savidge R.N., MSN
Occupational Health Coordinator
St. Anthony Summit Medical Center
970-668-6981 Phone
303-397-2013 Fax
PO Box 738
340 Peak One Dr.
Frisco, CO 80443
Nancysavidge at Centura.org<mailto:Nancysavidge at Centura.org>

From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Kate Miller
Sent: Thursday, August 03, 2017 11:33 AM
To: MCOH/EH <mcoh-eh at mylist.net>
Subject: Re: [MCOH-EH] TB skin test competencies [External]

This is one reason we went to Quant Golds. We had to do 2 step testing on hire and it was getting next to impossible to get people to come back for the second one. We do enough that we got a discount on the tests.
There were numerous complaints about not being able to have any RN or MD read the test however we also had numerous mis-reads, incorrect measurement of induration, measurements of redness but not induration etc.  We also had several cases where a positive test was recorded on the follow up sheet but we did not get called or notified and we were sent the slips days later. Even those who think that they are reading them correctly do not do it often enough in our low risk area.
Since we have been doing Quant Golds there is no longer the discrepancy and the employee only needs be there once. It was a win win.


Kate Miller, RN
Caregiver Health Nurse
541-706-4771 (office) 541-706-2694 (fax)
kemiller at stcharleshealthcare.org<mailto:kemiller at stcharleshealthcare.org>

St. Charles Health System 2500 NE Neff Road Bend OR 97701 www.stcharleshealthcare.org<http://www.stcharleshealthcare.org>

Drop In Calendar Link:
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From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Thrasher, Terri
Sent: Thursday, August 03, 2017 8:18 AM
To: MCOH/EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Subject: Re: [MCOH-EH] TB skin test competencies [External]

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-------- Original message --------
From: Amy Behrman <behrman at mail.med.upenn.edu<mailto:behrman at mail.med.upenn.edu>>
Date: 8/3/17 11:11 AM (GMT-05:00)
To: MCOH/EH <mcoh-eh at mylist.net<mailto: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<mailto: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<mailto:lawrence.budnick at rutgers.edu>
>
> CONFIDENTIALITY NOTICE: This email communication may contain private, confidential, or legally privileged information intended for the sole use of the designated and/or duly authorized recipient(s). If you are not the intended recipient or have received this email in error, please notify me immediately by email and permanently delete all copies of this email, including all attachments without reading them. If you are the intended recipient, please secure the contents in a manner that conforms to all applicable state and/or federal requirements related to privacy and confidentiality of such information. Thank you.
>
>
> -----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<mailto: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<mailto: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<mailto: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<mailto: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<mailto: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<mailto: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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> List archives (public): https://urldefense.proofpoint.com/v2/url?u=https-3A__na01.safelinks.protection.outlook.com_-3Furl-3Dhttp-253A-252F-252Fmylist.net-252Farchives-252Fmcoh-2Deh-252F-26data-3D02-257C01-257Cbudnicla-2540njms.rutgers.edu-257Cd3e6fe9d91434c7c0c5408d4da790ecb-257Cb92d2b234d35447093ff69aca6632ffe-257C1-257C0-257C636373660859468084-26sdata-3D4k6mkigL-252B4tOzRbnd2CWXbps4tmJu5lrgikNq-252BWo8I0-253D-26reserved-3D0&d=DwICAg&c=P0c35rBvlN7D8BNx7kSJTg&r=Jmg5o1TWVLt02_ZQHrHWz9cq2GUFrnmW1sIeobramoY&m=gxsUi8L2K22TiJYpZ8tcjGKFvFhRNKXByPltnM0VDdU&s=aZCMwihqCu9uVVkPpljWseHwLm1luetVQc0Ol9QhEPk&e=
> ---------------------------------------
> Send administrative requests to: drjoe at meditrax.com<mailto: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<mailto: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=https-3A__na01.safelinks.protection.outlook.com_-3Furl-3Dhttp-253A-252F-252Fwww.mcoh-2Deh.net-26data-3D02-257C01-257Cbudnicla-2540njms.rutgers.edu-257Cd3e6fe9d91434c7c0c5408d4da790ecb-257Cb92d2b234d35447093ff69aca6632ffe-257C1-257C0-257C636373660859468084-26sdata-3DGxz-252BosrK4h-252BdVMKfnqmRgOEWFTSqHMFPsCtNvnwKfHA-253D-26reserved-3D0&d=DwICAg&c=P0c35rBvlN7D8BNx7kSJTg&r=Jmg5o1TWVLt02_ZQHrHWz9cq2GUFrnmW1sIeobramoY&m=gxsUi8L2K22TiJYpZ8tcjGKFvFhRNKXByPltnM0VDdU&s=ojOIO-SVDXVxANffxsyFOVH79jhejrKWfmNLAMVfejM&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=https-3A__na01.safelinks.protection.outlook.com_-3Furl-3Dhttp-253A-252F-252Fmylist.net-252Farchives-252Fmcoh-2Deh-252F-26data-3D02-257C01-257Cbudnicla-2540njms.rutgers.edu-257Cd3e6fe9d91434c7c0c5408d4da790ecb-257Cb92d2b234d35447093ff69aca6632ffe-257C1-257C0-257C636373660859468084-26sdata-3D4k6mkigL-252B4tOzRbnd2CWXbps4tmJu5lrgikNq-252BWo8I0-253D-26reserved-3D0&d=DwICAg&c=P0c35rBvlN7D8BNx7kSJTg&r=Jmg5o1TWVLt02_ZQHrHWz9cq2GUFrnmW1sIeobramoY&m=gxsUi8L2K22TiJYpZ8tcjGKFvFhRNKXByPltnM0VDdU&s=aZCMwihqCu9uVVkPpljWseHwLm1luetVQc0Ol9QhEPk&e=
> ---------------------------------------
> Send administrative requests to: drjoe at meditrax.com<mailto: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<mailto: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<mailto: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<mailto: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<mailto:drjoe at meditrax.com>
---------------------------------------

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