Great summary by Dr. Swift and I also agree with Sally Foster-Chang’s baseline test.
So, I’m not adding anything to this conversation except support and endorsement!
Have a great day
😊,
Wendy
Wendy Todaro Thanassi MD, MA, MRO
Medical Director, Workforce Health and Wellness
Clinical Professor, Primary Care and Population Health Science
Stanford Medicine
300 Pasteur Dr., H0124
Stanford, CA 94303
Cell: 650-380-1131
thanassi@stanford.edu
Veterans Affairs Palo Alto Health Care System
3801 Miranda Ave, MC 11-EH
Palo Alto, CA 94304
Wendy.thanassi@va.gov
Dr. Thrasher, attached is the NTCA-ACOEM collaborative guidance document on TB testing and treatment in healthcare personnel. The preplacement evaluation
recommendations for HCP with a prior positive TB test begin at the bottom of page e358.
Recommendations are essentially the same for prior treated LTBI and prior treated active TB. Document the dates and confirmation of completed treatment.
For active TB they should have a clearance document from their public health department at the completion of therapy. A symptom screen would be recommended, but as long as she is asymptomatic and you have documentation of her prior positive IGRA and/or TST
at the time of her original diagnosis, documentation of complete treatment and clearance of the active infection, then there really is no testing or imaging recommended. The key will be obtaining that documentation. If she has none, then as Sally recommends
you could get an IGRA now (likely would be positive) and follow your usual clearance process. You can do a single view CXR with abdominal shielding, should records be unavailable and you need to exclude active TB. If you have the records though, no need to
image her unless she is symptomatic or her treatment wasn’t complete.
Melanie
Melanie Swift, MD, MPH
(she/her)
Vice Chair, Division of Public Health, Infectious Diseases and Occupational Medicine
Medical Director,
Mayo Clinic Physician Health Center
Associate Medical Director, Occupational Health Service
_______________________________
Mayo Clinic
200 First Street SW
Rochester, MN 55905
From: MCOH-EH <mcoh-eh-bounces+swift.melanie=mayo.edu@mylist.net>
On Behalf Of Sally Foster-Chang
Sent: Wednesday, February 8, 2023 11:20 AM
To: MCOH-EH <mcoh-eh@mylist.net>
Subject: [EXTERNAL] Re: [MCOH-EH] TB screening question
I’d do an IGRA. At least you would have a baseline.
Any recommendations for a new-hire nurse applicant? She is pregnant and
has previously been treated for active TB.
Thanks.
Dennis Thrasher, MD, MPH
sunnyside@dakotacom.net
520 247 1397
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