[MCOH-EH] [ExternalEmail] Re: Positive TB reactors

[Jordana L. Mcdonald]

Hello Everyone:

Here in Oregon the state TB Controller told us that we do not have to do annual signs and symptoms, but recommended that all staff sign a paper (we use their initial TB history/signs & symptoms) stating that they will report any signs of active TB to us immediately should they occur.  This may be helpful for those that develop signs or symptoms between screenings.  I am not sure how many of the employees (and this is all of the employees—housekeeping, food servers up through medical providers and directors) will actually remember to do this.  We have had very few reports of symptoms, but then choose follow up as appropriate.

Jordana


Jordana McDonald FNP-c
Salem Health Employee Health/Occupational Medicine
Salem Health Medical Group

SALEM HEALTH
Hospitals & Clinics
1002 Bellevue Street SE
Salem, OR 97301
Jordana.mcdonald at salemhealth.org<mailto:Jordana.mcdonald at salemhealth.org>
503-814-7250
Fax: 503-814-7253



From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of April Tainter
Sent: Thursday, March 01, 2018 7:32 AM
To: 'MCOH/EH' <mcoh-eh at mylist.net>
Subject: Re: [MCOH-EH] [ExternalEmail] Re: Positive TB reactors

Thank you all for your insight.  This is beyond helpful.

From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Lawrence Budnick
Sent: Thursday, March 01, 2018 9:10 AM
To: MCOH/EH
Subject: [ExternalEmail] Re: [MCOH-EH] Positive TB reactors

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CDC addresses this on page 30 of the 2005 Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings at https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5417a1.htm<https://imsva91-ctp.trendmicro.com:443/wis/clicktime/v1/query?url=https%3a%2f%2fwww.cdc.gov%2fmmwr%2fpreview%2fmmwrhtml%2frr5417a1.htm&umid=47A289E5-665B-4505-844F-4B3BA8DFAC5B&auth=ef4f5f1d68a7186ce2d79d9f05d548baf204f6b4-7f698d216f690be1e1ae6c7046cb63ebd62d7d3d>. It states, “Annual symptom screens should be performed, which can be administered as part of other HCW screening and education efforts.” This recommendation is not referenced and no data are presented to support this resource-intensive effort. Rather, there are several reports of outbreaks of TB in HCFs that have used annual symptom surveys on which HCWs reported negative symptom screens and went on to infect their patients, eg,  https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5450a2.htm<https://imsva91-ctp.trendmicro.com:443/wis/clicktime/v1/query?url=https%3a%2f%2fwww.cdc.gov%2fmmwr%2fpreview%2fmmwrhtml%2fmm5450a2.htm&umid=47A289E5-665B-4505-844F-4B3BA8DFAC5B&auth=ef4f5f1d68a7186ce2d79d9f05d548baf204f6b4-6da36d8d2ccedd72215b1c9fccde19999c1afa71> and NY Times 12/14/2015 page A16.

Years ago, we had 2 incidents, one involving a resident and another a medical student, where each completed a symptom survey (all answers negative) and then 4 to 6 months later developed active TB disease and potentially exposed patients, staff and students. Extensive follow-up testing revealed no secondary transmission.

Lawrence D. Budnick, MD, MPH
Director, Occupational Medicine Service
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>

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From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Thrasher, Terri (Terri)
Sent: Thursday, March 01, 2018 9:22 AM
To: MCOH/EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Subject: Re: [MCOH-EH] Positive TB reactors

We do an annual questionnaire as well

From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Steivang, Kristen
Sent: Thursday, March 01, 2018 9:10 AM
To: MCOH/EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Cc: MCOH-EH <mcoh-eh-bounces at mylist.net<mailto:mcoh-eh-bounces at mylist.net>>
Subject: Re: [MCOH-EH] Positive TB reactors

We also do annual questionnaire for any past positive.

Kristen

Kristen L. Steivang MSN, RN, ANP-BC, APNP
Employee Health Services
SSM Health St. Mary’s Hospital Madison
700 S Park St.
Madison  WI 53715
608-258-6995
Fax 608-259-3239

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From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Kathy.Dayvault at dekalbmedical.org<mailto:Kathy.Dayvault at dekalbmedical.org>
Sent: Wednesday, February 28, 2018 4:02 PM
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Cc: MCOH-EH <mcoh-eh-bounces at mylist.net<mailto:mcoh-eh-bounces at mylist.net>>
Subject: Re: [MCOH-EH] Positive TB reactors

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For past positve, we always do an annual TB Assessment.


Kathy Dayvault, RN, BSN, MPH
 Manager, Occupational Health and Safety
 WorksWell Onsite
 Dekalb Medical  2701 North Decatur Road
 Decatur, GA 30033
ph: 404.501.4972 Fax:404-501-2045
kathy.dayvault at dekalbmedical.org<mailto:kathy.dayvault at dekalbmedical.org>




From:        April Tainter <April.Tainter at thedacare.org<mailto:April.Tainter at thedacare.org>>
To:        "'mcoh-eh at mylist.net'" <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>,
Date:        02/28/2018 04:35 PM
Subject:        [MCOH-EH] Positive TB reactors
Sent by:        "MCOH-EH" <mcoh-eh-bounces at mylist.net<mailto:mcoh-eh-bounces at mylist.net>>
________________________________



Does anyone know if it is a requirement to assess for symptoms of active TB in past positive reactors?  I currently do a yearly questionnaire for symptoms but others in my system don’t.  Thank you for any guidance you can offer.

April Tainter RN
Employee Health Nurse

[Description: cid:image001.png at 01D0D11B.A449DA50]

ThedaCare Medical Centers-Shawano/New London/Waupaca
P 715-701-0168
F 715-524-9983

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