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The following article was published in our article directory on October 25, 2010.
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TB Screening in Healthcare workers

Article Category: Medical Business

Author Name: Lawrence Earl, MD

The CDC continuously updates guidelines with regard to control of tuberculosis (TB) infection in healthcare settings. This is in response to several factors:

1) a resurgence of tuberculosis (TB) disease that occurred in the United States within the mid-1980s and early 1990s

2) the documentation of multiple high-profile health-care--associated outbreaks related to an increase in the prevalence of TB illness and human immunodeficiency virus (HIV) coinfection

3) lapses in infection control practices

4) delays in the diagnosis and treatment of persons with infectious TB disease

5) the appearance and transmission of multidrug-resistant (MDR) TB strains

Some features of the updated guidelines of particular interest to the health care setting include a focus on risk assessment of foreign born workers, administration of those whom have received BCG vaccine, as well as the use of Interferon Gamma Release Assays (IGRAs), a new whole blood test, which may be used in addition to or instead of Tuberculin Skin Testing (TST) in Healthcare Workers (HCWs). In most cases, the frequency of serial testing for workers is reduced as a result of the new guidelines.

All healthcare facilities should have a comprehensive TB infection control plan that includes: Administrative controls, Environmental controls, and a Respiratory Protection Program. Within the Respiratory protection component, improvements to testing of healthcare workers is the focus of this discussion.

Many of our health care facility clients (nursing facilities in particular) employ foreign born employees. Rates of TB in the United States remain highest among these individuals. In addition, many might have received BCG vaccine in their home countries for protection against TB. You should note that vaccination with BCG does not reduce the risk of infection after exposure, although it may decrease the seriousness of TB disease and complications. Several questions are often raised regarding screening for TB in these individuals and in health care workers generally:

1. If they have a positive skin test reaction, when is it due to their BCG vaccine, and when does it mean they have "converted" from a negative reaction, indicating possible infection?

2. Do individuals who have had BCG vaccine need to be skin tested or should they get a chest x-ray every year?

3. What's the Interferon Gamma Release Assay (IGRA) and just how is it used in helping toassess TB status?

In a healthcare setting, the employees may be considered at moderate risk for TB infection, and should be tuberculin skin tested (TST-Mantoux) or IGRA, upon employing (using 2-step TST technique if formerly untested or undocumented, or over twelve months since previous) and then yearly. The yearly screening should include a symptom survey and TST/IGRA in those with previous negative tests. You are looking for conversion from the previously documented negative test to a positive test. In new hires who may have received BCG and their previous skin test is undocumented, they should undergo routine TST. BCG vaccine is NOT a contraindication to skin testing. In fact, in the event that it has been more than 5 years since the BCG vaccine, a positive skin test is probably the result of TB infection.

See our website for procedures to follow...

About the Author: Dr. Earl has 25 years experience in General and Occupational Medicine. Corporate health programs include consulting on all worker health related issues. See TB Testing Procedures here

Keywords: a postive skin test, bcg vaccine, guidelines for,guidelines for healthcare facilities, healthcare workers, IGRA, IGRA test, interferon gamma, Interferon Gold, LTBI, screening, skin test, skin testing, TB, TB test, TST, tuberculosis, updated tb testing guidelines

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