TB Screening in Healthcare workers
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The CDC continuously updates guidelines for control of tuberculosis (TB) infection in health care settings. This is in response to many factors:
1) a resurgence of tuberculosis (TB) disease that occurred in the United States in the mid--1980s and early 1990s
2) the documentation of multiple high-profile health-care--connected outbreaks related to an increase in the prevalence of TB disease 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 healthcare setting incorporate a focus on risk assessment of foreign born workers, management 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 employees is decreased 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, updates to screening of health care workers is the focus of this discussion.
A number of our health care service clients (nursing facilities in particular) employ foreign born employees. Rates of TB in the United States remain highest amongst these individuals. In addition, many may have received BCG vaccine in their home countries for prevention of TB. It is important to note that vaccination with BCG does not decrease the risk of infection after exposure, although it may decrease the severity of TB illness and complications. Several questions are often raised regarding testing for TB in these individuals and in health care workers generally:
1. Should they have a positive skin test reaction, when is this due to their BCG vaccine, and when does it mean they have "converted" from a negative reaction, indicating possible infection?
2. Do individuals who may 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 health care setting, the employees may be regarded as at moderate risk with regard to TB infection, and should be tuberculin skin tested (TST-Mantoux) or IGRA, upon employing (using two-step TST method if formerly untested or undocumented, or over 12 months since previous) and then annually. The annual screening should include a symptom survey and TST/IGRA in individuals with previous negative tests. You are looking for conversion from a previously documented negative test to a positive test. In new employs 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, if 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...
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Author Resource:-
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
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By :
Jessie Stone
Submitted
2010-10-27 09:41:08 |
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