Latent Tuberculosis Infection Testing Practices in Long‐Term Care Facilities, Boston, Massachusetts

Abstract

One-fifth of LTCF residents had LTBI, but testing was not always performed. The high prevalence of LTBI in older adults combined with the risk of an outbreak if a case of tuberculosis occurs in a LTCF make LTBI testing and treatment an important prevention opportunity. The importance of LTBI testing in LTCFs needs to be reinforced.

Detect to Prevent: Evaluating Testing and Treatment Practices for Latent Tuberculosis Infection in Long‐Term Care Facilities

“…Despite state and federal guidelines recommending LTBI testing for populations with a high risk for LTBI and TB transmission, including those living in LTCFs, Reddy and colleagues report that only 63% of residents in three inner-city LTCFs in the Boston area received LTBI testing despite those facilities serving a population at high risk (e.g., 48% with diabetes, 38% foreign-born, and 33% with chronic kidney disease). 7 Upon closer examination, one facility apparently accounted for the greatest proportion of missed testing opportunities, with only 28% of eligible residents tested; however, none of the three facilities had 100% testing for eligible residents, even among residents staying 3 months or longer as recommended by Massachusetts TB guidance in effect at the time of that study. 7 This potential gap in LTBI detection is of particular concern, given that among persons with tuberculin skin test (TST) results, the prevalence of LTBI was 20%, including 8% with a new positive TST result documented during the current LTCF stay.…”

“…7 Upon closer examination, one facility apparently accounted for the greatest proportion of missed testing opportunities, with only 28% of eligible residents tested; however, none of the three facilities had 100% testing for eligible residents, even among residents staying 3 months or longer as recommended by Massachusetts TB guidance in effect at the time of that study. 7 This potential gap in LTBI detection is of particular concern, given that among persons with tuberculin skin test (TST) results, the prevalence of LTBI was 20%, including 8% with a new positive TST result documented during the current LTCF stay. 7 An additional 8% had documentation of a TST being performed, but no result was documented.…”

“…7 This potential gap in LTBI detection is of particular concern, given that among persons with tuberculin skin test (TST) results, the prevalence of LTBI was 20%, including 8% with a new positive TST result documented during the current LTCF stay. 7 An additional 8% had documentation of a TST being performed, but no result was documented. 7 The variation in LTBI testing practices observed in this limited study should prompt providers and public health officials to evaluate LTBI testing practices in their own communities.…”

“…7 An additional 8% had documentation of a TST being performed, but no result was documented. 7 The variation in LTBI testing practices observed in this limited study should prompt providers and public health officials to evaluate LTBI testing practices in their own communities.…”

“…Reddy reports that four of 12 residents with newly documented positive LTBI test results during admission were offered LTBI treatment, of whom three completed therapy; however, no information was available for those with positive results before LTCF admission. 7 Facilities providing long-term care services need to have a process for follow-up of residents who are identified with LTBI. The need to develop an LTBI testing and treatment protocol should also be a consideration for other long-term care service providers, including adult day service centers, home health agencies, and assisted living communities, all of which provide care to an additional 7 million U.S. residents each year.…”