[MCOH-EH] QFG vs TSpot

Galaid Edward I Edward.Galaid at RoperSaintFrancis.com
Thu Feb 1 07:08:02 PST 2018
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We chose QFG over TSpot largely because of logistical issues.  It was a send-out for us, and  bundled with the rest of our LabCorp contract.  I can report on our favorable experience with QFG.  The size of the aliquot for each of the 3 tubes of the QFG was tiny.  Our nurses quickly mastered the collection and shake process, and over a couple of years, we did close to 2000 collections.  Our indeterminate frequency was barely 1%.  We had a handful of reversions.

We also went back to a two-step for budgetary reasons.  Wasn't my idea.


Edward I. Galaid, MD, MPH
ABIM, ABPM (OM)
Medical Director, Roper St. Francis Physician Partners Occupational Medicine
Charleston, SC
Member, ACOEM Task Group,  Guidance for the Medical Evaluation of Law Enforcement Officers
(O) 843-402-5053



-----Original Message-----
From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of mcoh-eh-request at mylist.net
Sent: Thursday, February 01, 2018 9:45 AM
To: mcoh-eh at mylist.net
Subject: MCOH-EH Digest, Vol 253, Issue 36

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Today's Topics:

   1. Re:  TB Risk Status - Medium (Mora, Jennifer)
   2. Re:  TB Risk Status - Medium (Denece O Kesler)


----------------------------------------------------------------------

Message: 1
Date: Thu, 1 Feb 2018 14:37:10 +0000
From: "Mora, Jennifer" <JMora at stohosp.com>
To: MCOH/EH <mcoh-eh at mylist.net>
Subject: Re: [MCOH-EH] TB Risk Status - Medium
Message-ID:
        <9D14022D5E54C44689C8FEDD2A877D8205538E at s201-exch-db1.stohosp.stohosp-inside.com>

Content-Type: text/plain; charset="us-ascii"

We used to use quantiferon gold, but went back to TB skin tests for about 2 years due to cost.  We recently switched to Tspot and have only run a couple so far.

Jen


Jennifer Mora MSN, RN
Business Health and Wellness Coordinator Stoughton Hospital
900 Ridge Street
Stoughton, WI 53589

Office 608-873-2204
Cell      608-235-4239



From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Thrasher, Terri (Terri)
Sent: Thursday, February 01, 2018 6:48 AM
To: MCOH/EH
Subject: Re: [MCOH-EH] TB Risk Status - Medium

I am curious if others consider using T spot.
A rep has contacted me and indicates the IDSA says T spot is superior and will only be 1 tube of blood and the new QFT has no pre analytics and requires 4 tubes.

Any thoughts on this to help me?

Kindest regards,

Terri

Terri L. Thrasher RN MSN
Sr. Director HR
Employee Health, Occupational Safety, Environmental Health, Employee Relations, Leave Management  HR Compliance/Policy, Workers Compensation, 803-SAFE, Injury Management, Non CCHMC Badging, Early Education and Childcare Center
3333 Burnet Ave
Cincinnati Ohio 45229  MLC 9006
513-636-6240





From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Thanassi, Wendy
Sent: Tuesday, January 16, 2018 7:00 PM
To: MCOH/EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Subject: Re: [MCOH-EH] TB Risk Status - Medium

You're welcome, any time. Here's another slide for you.

Wendy

From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Lisa Dyrdahl
Sent: Monday, January 15, 2018 9:33 AM
To: MCOH/EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Subject: [EXTERNAL] Re: [MCOH-EH] TB Risk Status - Medium

Wendy,
Thank you for this, it is most helpful especially with the citation for the guidelines.

Thanks again!

Lisa Dyrdahl, RN, BSN
Employee Health Nurse
Lisa_Dyrdahl at Valleymed.org<mailto:Lisa_Dyrdahl at Valleymed.org>
Ph: 425-228-3440 X5720
Fax: 425-656-5066

From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Thanassi, Wendy
Sent: Friday, January 12, 2018 12:31 PM
To: MCOH/EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Subject: Re: [MCOH-EH] TB Risk Status - Medium

Hello Lisa,

Yes, you can test some areas and not others.

The CDC 2005 and 2010 TB guidelines use the term "setting" for where annual TB testing should be done in medium and high risk areas. "Setting" allows that a huge hospital like ours would test certain areas, but not all people in all 102 building on all of our campuses. "Setting" is generally shared airspace, so if all 6 came through the medicine clinic, that area would become high risk but the O.R. would not.  (Of course shared airspace can be extended indefinitely to include the whole earth if one gets really energetic...) In sum, such surveillance should be undertaken in a reasonable manner to capture employees truly at risk for exposure but without wasting time, money and productivity hours chasing those who are not.

Newer guidelines will come out soon, and those are likely to be more flexible.

Wendy

Wendy Thanassi MA, MD
Chief, Occupational Health Service
Office of the Associate Director
Palo Alto VAHCS, California
650-493-5000 x 11-65214

Clinical Associate Professor
Stanford Hospital and Clinics

National Lead, Tuberculosis
Veteran's Health Administration 10P4Z
Washington, DC

[Description: Description: cid:image001.jpg at 01CE4591.3F9AB100]
Providing the best Occupational Medicine Care Anywhere-for VHA Employees and Veterans VHAOccupationalEnviroMedConsult at va.gov<mailto:VHAOccupationalEnviroMedConsult at va.gov>  or https://vaww.portal.va.gov/sites/ohshg/OEMedicineConsults

From: MCOH-EH [mailto:mcoh-eh-bounces+wendy.thanassi=va.gov at mylist.net] On Behalf Of Deborah A. Pruim via MCOH-EH
Sent: Friday, January 12, 2018 9:08 AM
To: MCOH/EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Cc: Deborah A. Pruim <dpruim at lcmh.org<mailto:dpruim at lcmh.org>>
Subject: [EXTERNAL] Re: [MCOH-EH] TB Risk Status - Medium

We are a low risk hospital.  We require annual screening (questionnaire) yearly for all employees.
All new hires are tested with a 2 step PPD at hire.  If they have had BCG we do a Quanteferon Gold test.
Thanks,
Debbie
Deborah Pruim, RN, MSN, APN, CNS
Employee Health Services
Little Company of Mary Hospital
2800 W. 95th Street
Evergreen Park, IL  60805
Monday - Friday
6:30am-3pm
Phone:  708-229-5623
Fax:  708-229-6618
dpruim at lcmh.org<mailto:dpruim at lcmh.org>
[cid:image001.png at 01D2A32C.E73F4EA0]



From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Lisa Dyrdahl
Sent: Thursday, January 11, 2018 11:31 AM
To: MCOH/EH
Subject: [MCOH-EH] TB Risk Status - Medium

MCOH List Serve,
We have been a Low Risk hospital for TB and have not performed Annual testing since 2009.  We have now entered Medium Risk, (>6 patients with >200 beds).   According to the 2005 TB Prevention Guidelines we must now:

*         Test all HCWs on hire - (Which we have always done as Low Risk using QFG)

*         Test all HCWs at least every 12 months

*         Preform TB Symptom Screen for all HCWs with baseline negative results

My question for the list is whether we can test only High Risk Depts for TB or do we have to test all HCWs throughout the entire hospital?

Do we also need to provide symptom screening for everyone who test negative on baseline?  We currently do this for all Positive results only.

I had thought there was an option to either test all employees or only those in Hi Risk areas but I can't find this documented.

Thank you.

Lisa Dyrdahl, RN, BSN
Employee Health Nurse
Lisa_Dyrdahl at Valleymed.org<mailto:Lisa_Dyrdahl at Valleymed.org>
Ph: 425-228-3440 X5720
Fax: 425-656-5066


DISCLAIMER: This message is confidential, intended only for the named recipient(s) and may contain information that is privileged or exempt from disclosure under applicable law. If you are not the intended recipient(s), you are notified that the dissemination, distribution or copying of this information is strictly prohibited. If you received this message in error, please notify the sender then delete this message.

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------------------------------

Message: 2
Date: Thu, 1 Feb 2018 14:44:51 +0000
From: Denece O Kesler <DKesler at salud.unm.edu>
To: 'MCOH/EH' <mcoh-eh at mylist.net>
Subject: Re: [MCOH-EH] TB Risk Status - Medium
Message-ID:
        <aa7de7a1a2d4464a971df19d54f49f65 at UH-XCHMBX8.hsc.ad.unm.edu>
Content-Type: text/plain; charset="us-ascii"

Dr. Allen-Hardy,
It may be your lab is the source of the invalid results, which I have seen with QFT results from a local lab.

Denece Kesler, MD, MPH
Medical Director
UNMH OHS


From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Thrasher, Terri (Terri)
Sent: Thursday, February 1, 2018 6:06 AM
To: MCOH/EH <mcoh-eh at mylist.net>
Subject: Re: [MCOH-EH] TB Risk Status - Medium

Interesting we have very very few  invalids with QFT

From: MCOH-EH [mailto:mcoh-eh-bounces+terri.thrasher=cchmc.org at mylist.net] On Behalf Of Allen-Hardy, Blythe
Sent: Thursday, February 01, 2018 8:02 AM
To: MCOH/EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Subject: Re: [MCOH-EH] TB Risk Status - Medium

We are a large hospital system and test everyone for TB annually even contractors such as food service workers, etc. New-hires get T Spot. However, we have a high invalid result rate. Unsure why and need to look into this further since our lab processes them in house. Annually we administer the PPD. If the PPD has been previously positive, we administer a TB questionnaire and make sure they have a CXR on file. May look into quantiferon since we are seeing so many invalid t spot results.

[Description: https://secure-web.cisco.com/1lQLN6EjA7GAIeD1D7bWr_7sqKg97m1VKbgxgx2JCdYeL6FzTohFT8Kw25-X8hO8oEyeb3pXbQMz5c2yBRunYT3gWWEL529sUaHw0GRyB5_IijTxoROtwRhfEbRgbqomxCg8IK6hHfCrFLgFfOlrb9z6eQ5ZbQvDbZfM1c7r7ILDSp4Lq6Wrhy1VfScSeJP80fTIEBd1mOreZtnw95GCcBV9bEkTvkIlwYNaYsBzzxv05LHWkM_sNRkzwjbJ8UsvV013hd95JLo_ThV-sOCdfRtj5YYvyBL3ur5DbnYwfjqGCjJKJm-gJ0WVO1XRPYLnG994DcnSi-BbZ8k4LFETZbA/https%3A%2F%2Fsecure1.mhhs.org%2Fbranding%2FCORPORATE_DOWNLOADS%2FUSER_TEMPLATES%2FSYSTEM%2Femail_signature%2FMHH_ESIGLogo.jpg]

Blythe Allen-Hardy, MD, FACOEM
Medical Director, Employee Health
Texas Medical Center
6411 Fannin, JB500
Houston, Texas, 77030
W: 713-704-2792
C: 720-840-9593
F: 713-704-6350
Blythe.allen-hardy at memorialhermann.org<mailto:Blythe.allen-hardy at memorialhermann.org>

From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Thrasher, Terri (Terri)
Sent: Thursday, February 01, 2018 6:48 AM
To: MCOH/EH
Subject: [EXTERNAL] Re: [MCOH-EH] TB Risk Status - Medium

I am curious if others consider using T spot.
A rep has contacted me and indicates the IDSA says T spot is superior and will only be 1 tube of blood and the new QFT has no pre analytics and requires 4 tubes.

Any thoughts on this to help me?

Kindest regards,

Terri

Terri L. Thrasher RN MSN
Sr. Director HR
Employee Health, Occupational Safety, Environmental Health, Employee Relations, Leave Management  HR Compliance/Policy, Workers Compensation, 803-SAFE, Injury Management, Non CCHMC Badging, Early Education and Childcare Center
3333 Burnet Ave
Cincinnati Ohio 45229  MLC 9006
513-636-6240





From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Thanassi, Wendy
Sent: Tuesday, January 16, 2018 7:00 PM
To: MCOH/EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Subject: Re: [MCOH-EH] TB Risk Status - Medium

You're welcome, any time. Here's another slide for you.

Wendy

From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Lisa Dyrdahl
Sent: Monday, January 15, 2018 9:33 AM
To: MCOH/EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Subject: [EXTERNAL] Re: [MCOH-EH] TB Risk Status - Medium

Wendy,
Thank you for this, it is most helpful especially with the citation for the guidelines.

Thanks again!

Lisa Dyrdahl, RN, BSN
Employee Health Nurse
Lisa_Dyrdahl at Valleymed.org<mailto:Lisa_Dyrdahl at Valleymed.org>
Ph: 425-228-3440 X5720
Fax: 425-656-5066

From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Thanassi, Wendy
Sent: Friday, January 12, 2018 12:31 PM
To: MCOH/EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Subject: Re: [MCOH-EH] TB Risk Status - Medium

Hello Lisa,

Yes, you can test some areas and not others.

The CDC 2005 and 2010 TB guidelines use the term "setting" for where annual TB testing should be done in medium and high risk areas. "Setting" allows that a huge hospital like ours would test certain areas, but not all people in all 102 building on all of our campuses. "Setting" is generally shared airspace, so if all 6 came through the medicine clinic, that area would become high risk but the O.R. would not.  (Of course shared airspace can be extended indefinitely to include the whole earth if one gets really energetic...) In sum, such surveillance should be undertaken in a reasonable manner to capture employees truly at risk for exposure but without wasting time, money and productivity hours chasing those who are not.

Newer guidelines will come out soon, and those are likely to be more flexible.

Wendy

Wendy Thanassi MA, MD
Chief, Occupational Health Service
Office of the Associate Director
Palo Alto VAHCS, California
650-493-5000 x 11-65214

Clinical Associate Professor
Stanford Hospital and Clinics

National Lead, Tuberculosis
Veteran's Health Administration 10P4Z
Washington, DC

[Description: Description: cid:image001.jpg at 01CE4591.3F9AB100]
Providing the best Occupational Medicine Care Anywhere-for VHA Employees and Veterans VHAOccupationalEnviroMedConsult at va.gov<mailto:VHAOccupationalEnviroMedConsult at va.gov>  or https://vaww.portal.va.gov/sites/ohshg/OEMedicineConsults<https://secure-web.cisco.com/1nCuH2ToVePL5OMBBKX-wPhJy7S4Rjqt_nE4dfkF2gxRN8z32X9GFYra9NMFtwceE2TPFIxTnoCfjl9eeA5kJOam_HsJzf8Jzfc5XzzTiOLMMScJUrtR2cOCilcGYdOnN1RXQvopvoLITaxRHSN7VgAflKEoYxEwze6AWGNqoBw7ui4co4yNOehrwan2cq7k5EWOjdB_RIKPiGlyMXjD-B1TsayenEIdp8X_C-6ffr8YEfEnBHFL7_aHFZFuTp0qV1zKC4FVMgriKsia45wIsN_lnZyFU7ieJQemfu3sa2If1v0qyyYz7dwQaPWu1HS4x/https%3A%2F%2Furldefense.proofpoint.com%2Fv2%2Furl%3Fu%3Dhttps-3A__vaww.portal.va.gov_sites_ohshg_OEMedicineConsults%26d%3DDwMFAg%26c%3DcBOA5YEoZuz9KdLvh38YxdrPtfJt83ckXekfBgq5xB0%26r%3DwByle5B7g0fslsnNW78BQ2Q9NDuRqCRsXQPmcNL4vQVaaoQwcJuwzXqV2KJq9TaN%26m%3D6fNIG_vfek3IMTY87v6PbYFsZmj3aQJMjhn0uiKhiN4%26s%3DqXeZc4UGGPzCXuxLsUM7iGFcq3yzDCUU3cXEPz8Ss6o%26e%3D>

From: MCOH-EH [mailto:mcoh-eh-bounces+wendy.thanassi=va.gov at mylist.net] On Behalf Of Deborah A. Pruim via MCOH-EH
Sent: Friday, January 12, 2018 9:08 AM
To: MCOH/EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Cc: Deborah A. Pruim <dpruim at lcmh.org<mailto:dpruim at lcmh.org>>
Subject: [EXTERNAL] Re: [MCOH-EH] TB Risk Status - Medium

We are a low risk hospital.  We require annual screening (questionnaire) yearly for all employees.
All new hires are tested with a 2 step PPD at hire.  If they have had BCG we do a Quanteferon Gold test.
Thanks,
Debbie
Deborah Pruim, RN, MSN, APN, CNS
Employee Health Services
Little Company of Mary Hospital
2800 W. 95th Street
Evergreen Park, IL  60805
Monday - Friday
6:30am-3pm
Phone:  708-229-5623
Fax:  708-229-6618
dpruim at lcmh.org<mailto:dpruim at lcmh.org>
[cid:image001.png at 01D2A32C.E73F4EA0]



From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Lisa Dyrdahl
Sent: Thursday, January 11, 2018 11:31 AM
To: MCOH/EH
Subject: [MCOH-EH] TB Risk Status - Medium

MCOH List Serve,
We have been a Low Risk hospital for TB and have not performed Annual testing since 2009.  We have now entered Medium Risk, (>6 patients with >200 beds).   According to the 2005 TB Prevention Guidelines we must now:

*         Test all HCWs on hire - (Which we have always done as Low Risk using QFG)

*         Test all HCWs at least every 12 months

*         Preform TB Symptom Screen for all HCWs with baseline negative results

My question for the list is whether we can test only High Risk Depts for TB or do we have to test all HCWs throughout the entire hospital?

Do we also need to provide symptom screening for everyone who test negative on baseline?  We currently do this for all Positive results only.

I had thought there was an option to either test all employees or only those in Hi Risk areas but I can't find this documented.

Thank you.

Lisa Dyrdahl, RN, BSN
Employee Health Nurse
Lisa_Dyrdahl at Valleymed.org<mailto:Lisa_Dyrdahl at Valleymed.org>
Ph: 425-228-3440 X5720
Fax: 425-656-5066


DISCLAIMER: This message is confidential, intended only for the named recipient(s) and may contain information that is privileged or exempt from disclosure under applicable law. If you are not the intended recipient(s), you are notified that the dissemination, distribution or copying of this information is strictly prohibited. If you received this message in error, please notify the sender then delete this message.

DISCLAIMER: This message is confidential, intended only for the named recipient(s) and may contain information that is privileged or exempt from disclosure under applicable law. If you are not the intended recipient(s), you are notified that the dissemination, distribution or copying of this information is strictly prohibited. If you received this message in error, please notify the sender then delete this message.
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