[MCOH-EH] Re invalid tspots- MCOH-EH Digest, Vol 253, Issue 35

Cindy M. Hansen Chansen at mhg.com
Thu Feb 1 05:11:29 PST 2018
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We found that our quatiferon gold QTF tests that we sent to a lab in California gave us a bunch of false positives.  We changed to Tspot and no longer have the problem.

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> On Feb 1, 2018, at 7:06 AM, "mcoh-eh-request at mylist.net" <mcoh-eh-request at mylist.net> wrote:
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> Today's Topics:
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>   1. Re:  TB Risk Status - Medium (Thrasher, Terri (Terri))
>
>
> ----------------------------------------------------------------------
>
> Message: 1
> Date: Thu, 1 Feb 2018 13:06:08 +0000
> From: "Thrasher, Terri (Terri)" <Terri.Thrasher at cchmc.org>
> To: MCOH/EH <mcoh-eh at mylist.net>
> Subject: Re: [MCOH-EH] TB Risk Status - Medium
> Message-ID: <0d666fcd97bd4fb8a2004db8ad512c8d at cchmc.org>
> Content-Type: text/plain; charset="us-ascii"
>
> 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>
> 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://secure1.mhhs.org/branding/CORPORATE_DOWNLOADS/USER_TEMPLATES/SYSTEM/email_signature/MHH_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://urldefense.proofpoint.com/v2/url?u=https-3A__vaww.portal.va.gov_sites_ohshg_OEMedicineConsults&d=DwMFAg&c=cBOA5YEoZuz9KdLvh38YxdrPtfJt83ckXekfBgq5xB0&r=wByle5B7g0fslsnNW78BQ2Q9NDuRqCRsXQPmcNL4vQVaaoQwcJuwzXqV2KJq9TaN&m=6fNIG_vfek3IMTY87v6PbYFsZmj3aQJMjhn0uiKhiN4&s=qXeZc4UGGPzCXuxLsUM7iGFcq3yzDCUU3cXEPz8Ss6o&e=>
>
> 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
>
>
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