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As previously forecasted in Hospital Infection Control & Prevention, the CDC officially dropped routine annual tuberculosis testing of healthcare workers (HCWs) in recently published guidelines.1 (For more information, see the April 2019 issue of HIC.)
The agency is dropping routine screening in favor of testing on hire, and after TB exposure or ongoing transmission. In updating 2005 TB guidelines, the CDC screening change was expected as the disease continues to decline nationally and healthcare workers appear to be at no greater risk of transmission than the general public.
“In addition, a recent retrospective cohort study of approximately 40,000 healthcare personnel at a tertiary U.S. medical center in a low TB-incidence state found an extremely low rate of TST [tuberculin skin test] conversion (0.3%) during 1998-2014, with a limited proportion attributable to occupational exposure,” the CDC reported.1,2
Routine annual screening in low-risk populations has little epidemiological value, and could trigger false positives and unnecessary anxiety in healthcare workers.
“The recommendation is a lot more strongly stated that we really don’t need to be doing annual testing in almost every situation,” says lead author Lynn Sosa, MD, TB/STD Control Programs Coordinator at the Connecticut Department of Public Health. “This will save time because now you are not focused on tracking down people to get them tested every year.”
Oher CDC TB recommendations include:
There also is new emphasis on treating HCWs who test positive for LTBI. IPs played a large role in implementing TB infection control measures that made this possible. IPs must continue to emphasize rapid identification and isolation of TB patients.
“The 2005 recommendations3 still stand in terms of the infection control and the environmental control recommendations,” Sosa says. “Those are still really important. Just doing a test on healthcare workers does not prevent TB transmission.”
As part of the preplacement TB test for healthcare workers, the CDC recommends an individual risk assessment. “Instead of looking at the risk of a particular facility, we are focused on the risk of the individual person working in the healthcare setting,” Sosa says. “Because it really is important to understand what that individual’s risk of TB is to interpret and better understand the test results.”
HCWs should be considered at increased risk for TB if they answer yes to any one of the following statements:
Financial Disclosure: Peer Reviewer Patrick Joseph, MD, reports that he is a consultant for Genomic Health, Siemens, and CareDx. Medical Writer Gary Evans, Editor Jill Drachenberg, Editor Jonathan Springston, Nurse Planner Patti Grant, RN, BSN, MS, CIC, Accreditations Manager Amy M. Johnson, MSN, RN, CPN, and Editorial Group Manager Leslie Coplin report no consultant, stockholder, speaker’s bureau, research, or other financial relationships with companies having ties to this field of study.