[MCOH-EH] HCP staffing hemodialysis units

[Wendy Thanassi]

Hello colleagues,
I don't know what the regulations are nationally - if any - but I just gave
a talk on TB in dialysis and I'll offer a few bullet points from what I
learned:

HD patients have (compared with healthy hosts) a:

   - 6 - 25 x higher rate of LTBI incidence rate
   - 10 - 25 x likelihood of progressing from LTBI to active TB
   - 2 - 3 x likelihood of dying from active TB (US mortality rate is
   10-15%, so that's a 30-45% mortality)
   - SO: IF an employee of yours gets active TB and brings it into the
   unit, patients will die
   - SO: I'd advocate an up-to-date blood TB test (QFT is best) for
   onboarding (not annual) HD employees AND LTBI treatment be initiated with
   3HP or 4 RIF if they have LTBI. You can have them sign a declination form
   if they refuse treatment, an example of one is in our 2020 JOEM TB guidance
   paper.

That's my 2 cents for free!

Happy Friday,
Wendy

VA Palo Alto HCS

On Thu, Nov 14, 2024 at 11:23 PM Malgorzata Hasek <mdhasek at gmail.com> wrote:

> Good morning regarding any additional onboarding or periodic evaluations
> of healthcare personnel staffing hemodialysis units:
> I have reviewed the attached prior posting.
> We are meeting with infection control, and the dialysis unit director to
> review any additional requirements.
> If you do any additional OH services in addition to routine onboarding
> immunity screening for this group of HCP, please advise.
> I know there are specific recommendations for HD patients, but I am not
> aware of any for HCP other than documenting Hep B immunity (which we do at
> onboarding for all).
> Thanks!
> Margaret Hasek MD MPH FACOEM FACPM
> Chicago
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