Routine tuberculosis testing for hospital employees - adapted from the Archives of Internal Medicine

Date: Oct, 1995

The Centers for Disease Control and Prevention (CDC) recommends testing hospital employees for infection with Mycobacterium tuberculosis before employment and at routine intervals. Testing at six-month intervals is recommended for high-risk employees based on a documented high rate of exposure to patients with tuberculosis. If a purified protein derivative (PPD) skin test is negative, the test should be repeated 12 weeks after the exposure. For individuals with a skin test reaction of 5 mm or more of induration, a chest radiograph is recommended. Ramaswamy and associates performed a cost-benefit analysis of tuberculin skin testing over a four-year period in a community hospital.

High-risk employees were defined as persons who worked daily in patient care, and low-risk employees were defined as those who were not directly involved in patient care. Skin tests were administered and interpreted, converters were identified, and prophylaxis was prescribed when appropriate. A total of 4,419 screening tests were performed over the four-year study period. The number of high-risk employees exposed to tuberculosis was 345, with the cumulative conversion rate averaging 1.4 percent.

The number of reactive PPD tests over two years demonstrated that of the total number of conversions, 42 percent occurred among nursing staff, 6 percent occurred among physicians and residents and 52 percent occurred among ancillary staff. No differences in conversion rates were apparent between medical and nonmedical employees. Conversions were not confined to any one particular group involved in specific high-risk tasks. No boosting phenomenon with the two-step tuberculin skin test was noted.

The authors believe that adhering to the CDC recommendations would result in enormous financial and staffing constraints for many community hospitals. Instead, they recommend six-month testing of high-risk employees and 12-month surveillance of low-risk employees. Repeating the PPD test after exposure and again at 12 weeks does not appear to be warranted. This policy would ease the administrative and financial burden on hospitals and increase employee compliance. (Archives of Internal Medicine, August 17/21, 1995, vol. 155, p.1637.)

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