Agree with Laura, letting others read a TST is fraught. I have in the past allowed screening reads by physicians and APPs, with a guided reading instruction that asks for erythema and induration separately; with a required second read by our trained staff for any erythema OR induration. We would only place a TST on Thursday if the individual had access to a physician or APP to screen it over the weekend. Of course most did not. The CDC training module for places my and reading a TST is very long - 4 or 8 hrs I think - but we did train inpatient RNs as screening readers who could confirm a complete lack of reaction on a weekend on the unit. Probably not feasible for your situation in 2024, as almost all TB testing is now at onboarding and there are extremely few healthcare workers who need ongoing surveillance after they have started working in the hospital.

Melanie

From: MCOH-EH <mcoh-eh-bounces@mylist.net> on behalf of RADKE, LAURA via MCOH-EH <mcoh-eh@mylist.net>
Sent: Friday, March 15, 2024 4:36:32 PM
To: MCOH-EH <mcoh-eh@mylist.net>
Cc: RADKE, LAURA <laura.radke@froedtert.com>
Subject: [EXTERNAL] Re: [MCOH-EH] TB testing (TST): tuberculin skin testing
 

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!

 

  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?
  1. 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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