[MCOH-EH] TB testing (TST): tuberculin skin testing

[Wendy Thanassi]

*Hello Darryl and all,*

*I am potentially no help at all... but all of the logistic and medical
(lack of follow-up, documentations and recording challenges, quality
challenges) are alleviated by using an IGRA blood test. May I ask why you
don't do that and if there is anything I can do to discuss the possibility
with you or your clinic?*

*We eliminated TST testing all together on January 1, 2009 and have never
done one since then. PLEASE feel free to contact me if there's room for
discussion on use, location, cost, efficiency etcetera!*

*To answer these below:*
*1. No*
*a. No*
*b. The standard is to use IGRAs: since 2017 when the joint CDC/ ATS/ IDSA
/ACOEM guidances were written that say "IGRA is preferred over TST IN ALL
SETTINGS" for many reasons, including the ones you raise above. But first
and foremost because it is much more reliable, and MMR/VZV titres are
usually being drawn anyway.*

*I suppose it'd be fine to do in separate places if you're still using TST,
you'd just need good documentation. *

*Or.... do a QFT/TSPOT and then the whole problem goes away?! :)*

*2. Because of incubation availability, draw IGRA's until 2pm Friday and
then we give the lab a few hours to process it.*

*I don't mean to be a pain, I mean to be helpful. Let me know if there's
more I can do to help you get out from under TSTs.*

*Best always,*
*Wendy*

*Wendy Thanassi MD, MA, MRO*
*VA Palo Alto HCS*

On Thu, Mar 14, 2024 at 10:09 AM Lesoski, Darryl via MCOH-EH <
mcoh-eh at mylist.net> wrote:

> Couple of questions:  THANKS for any input, feedback, suggestions!
>
>
>
>    1. Does any provider or clinic place TSTs for patients and let them go
>    elsewhere for the read/interpretation?
>       1. What is our liability if we administer the TST, but allow
>       interpretation elsewhere?
>       2. What is the current practice standard for administration and
>       interpretation of a TST? They should always be done in the same
>       clinic/practice? Or can they be completed at 2 separate and non-related
>       clinics/practices?
>    2. Does any provider or clinic *NOT* place TSTs on THURSDAYs because
>    you are not available on the Saturday or Sunday to provider the
>    interpretation?
>
>
>
> We have created some scenarios with the guidance/recommendations at our
> medical center that hampers our clinical operations to outside
> clients/businesses and want to know what the rest of you are all doing 😊
>
>
>
> Personally, I have no qualms letting my staff administer the TST and
> allowing the individual to go elsewhere for interpretation (but then again,
> I may be a little more “liberal” in my practice processes than others).
>
>
>
> THANKS for the reply and appreciate your input.   Darryl
>
>
>
>
>
> *Darryl Lesoski, MD, MPH, FACOEM*
>
>
>
> *System Medical Director – Occupational Health and Medicine, Employee
> Health*
>
> *Munson Medical Center*
>
> *Munson Occupational Health and Medicine*
>
> *Email: dlesoski at mhc.net <dlesoski at mhc.net>*
>
>
>
> *     TRAVERSE CITY*
>
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>
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>
> *Office 231-935-8590 | Fax 231-935-8597*
>
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>
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>
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>
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>
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>
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>
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>
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