WE have also converted completely to IGRA for our own employees and encourage our external clients to do the same. For those who insist on a TST, we do not do them on Thursdays for the reasons mentioned. We rarely, if ever, let an outside agency read the TST. Our providers would not be comfortable signing off on a read that was not performed in our clinic. IGRA is generally much easier to manage and interpret.
Laura
Laura L Radke, MD
Adjunct Assistant Professor of Medicine
Senior Medical Director, F&MCW Occupational Health Services
Phone: 262-253-8197 | Fax: 262-253-5152 Cell Phone: 414-530-0723
E-mail: laura.radke@froedtert.com
Froedtert & the Medical College of Wisconsin Workforce Health / North Hills Health Center
Building B First Floor
W129 N7055 Northfield Dr.
Menomonee Falls, WI 53051
From: MCOH-EH <mcoh-eh-bounces+laura.radke=froedtert.com@mylist.net>
On Behalf Of Wendy Thanassi
Sent: Thursday, March 14, 2024 3:19 PM
To: MCOH-EH <mcoh-eh@mylist.net>
Subject: Re: [MCOH-EH] TB testing (TST): tuberculin skin testing
|
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 |
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@mylist.net> wrote:
Couple of questions: THANKS for any input, feedback, suggestions!
- Does any provider or clinic place TSTs for patients and let them go elsewhere for the read/interpretation?
- What is our liability if we administer the TST, but allow interpretation elsewhere?
- 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?
- 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@mhc.net
TRAVERSE CITY
Mailing: 1105 Sixth Street, FFCHC, Occ Medicine 49684
Physical: 550 Munson Avenue, 1st Floor 49686
Office 231-935-8590 | Fax 231-935-8597
CADILLAC
Address: 803 Lynn Street, Cadillac 49601
Office 231-876-6180 | Fax 231-876-6080
GRAYLING
Address: 1100 East Michigan Ave, Grayling 49738
Office 989-348-0368 | Fax 989-348-0773
ELMIRA
Address: 2572 US-131, Elmira 49730
Office 989-731-7700 | Fax 231-231-8714
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