CDC says low-risk hospitals can halt annual TB tests

New guideline eases tracking where TB rare

The tedious job of tracking tuberculin skin tests for hundreds, or even thousands, of employees has ended for hospitals that rarely treat patients with tuberculosis.

In guidelines released late last year, the Centers for Disease Control and Prevention (CDC) advised that hospitals that are "low risk" based on a risk assessment do not need to conduct annual TB screening. Without the burden of that task, employee health professionals have been able to focus on other projects, including injury prevention and wellness.

"It does free up an awful lot of time," says Deborah Rivera, RN, COHN, occupational health nurse supervisor at Children's Mercy Hospitals and Clinics in Kansas City, MO. "It was something we monitored very carefully. You wanted your compliance to be 100%, if at all possible, and we worked hard to do that. I'm glad it's gone."

Until this year, Children's Mercy conducted 7,000 to 10,000 TB tests a year, including two-step baseline tests. The hospital will continue to conduct two-step baseline tests on new employees, or a total of about 3,000 tests. The reduction will save an estimated $50,000, much of that in staff time.

In its 2005 Guidelines for Preventing Transmission of Mycobacterium tuberculosis in Health-Care Settings, the CDC classified hospitals as low risk if they had more than 200 beds and fewer than six TB patients in the preceding year, or if they had fewer than 200 beds and fewer than three TB patients in the preceding year.1

Children's Mercy met the criteria, so Rivera brought the issue to the hospital's infection control committee and got the approval of the public health department. The hospital still provides annual education to employees about TB, monitors employee symptoms, and conducts an annual risk assessment.

If the risk status changes or transmission occurs, employees would need to have baseline, two-step tests if they have not had a TB test within the past 12 months, says Paul Jensen, PhD, PE, engineer director with the U.S. Public Health Service and the CDC's division of TB elimination. Employees who move to a new setting, even if it is low risk and within the same facility, would need the two-step test, he says. (Different units, such as the emergency department, may carry different risk assessments.)

So nurses who "float" among different departments still may need annual TB testing even if they're in a low-risk facility, Jensen says. For other employees who transfer settings, the two-step testing could be avoided by using a TB blood test such as QuantiFERON-TB Gold, he notes.

Now employees want TB tests

It seems strange to end annual TB testing, Rivera acknowledges. After all, conducting TB skin tests has long been a significant task for employee health — and one often reviewed by visiting surveyors from the Joint Commission on Accreditation of Healthcare Organizations.

Employees also had grown accustomed to the annual screening. So paradoxically, employee health professionals who once spent hours reminding employees and following up on those who didn't get their tests now field requests from employees who still want the TB tests even if they're not required.

"Danville Regional Medical Center continues to offer annual TB testing to its associates, with almost all associates choosing to receive it," says Peggy Taylor, RN, COHN-CM, employee health nurse at the center in Virginia. "It seems like more so now than before, but it might be my imagination."

Employee health won't track down the employees to make sure they return for their test result to be read. But Taylor tells them, "'There's no point in my placing it if you're not going to get it read,'" adding that they usually do come back.

As at many rural hospitals, Phyllis Radcliff, RN, employee health nurse at St. Mary's Hospital in Streator, IL, once spent hours following up on employees who had failed to get their TB screens within the designated time. All of the hospital's 520 employees received annual TB tests, although the hospital hasn't treated a confirmed TB patient in at least five years.

"It had always been a battle getting everybody to do their annual TB testing," she says. The hospital still conducts annual respirator fit-testing and provides TB education as a part of that. Employees may receive the annual TB test free of charge, if they want one, a policy that particularly benefits nursing students who need it for school, Radcliff says.

But with an end to mandatory testing, Radcliff says she will have at least a few extra hours a week to focus on improving employee health and preventing injuries.

Reference

1. Jenson et al. Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005. MMWR Recomm Rep. 2005; 54(RR17):1-141.