Costs of Implementing and Maintaining a Tuberculin Skin Test Program in Hospitals and Health Departments

Lambert, Lauren A.; Rajbhandary, Sameer; Qualls, Noreen L.; Budnick, Lawrence D.; Catanzaro, Antonino; Cook, Sharlette V.; Daniels-Cuevas, Linda; Garber, Elizabeth; Reves, Randall

doi:10.1086/502142

Cited by 27 publications

(9 citation statements)

References 9 publications

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“…Similarly, workers with booster reactions on 2-step tuberculin testing (10% of our cohort) could also be discharged by nurses, if their radiographs are normal and they have no other medical risks. Lambert and colleagues identified personnel costs, training and education as the major cost drivers of a TST screening program [21]. Implementation of a protocol of this type could reduce superfluous evaluations by TB specialists, and reduce costs.…”

Section: Discussionmentioning

confidence: 99%

Referrals for positive tuberculin tests in new health care workers and students: a retrospective cohort study

Schwartzman

2010

BMC Public Health

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BackgroundDocumentation of test results for latent tuberculosis (TB) infection is important for health care workers and students before they begin work. A negative result provides a baseline for comparison with future tests. A positive result affords a potential opportunity for treatment of latent infection when appropriate. We sought to evaluate the yield of the referral process for positive baseline tuberculin tests, among persons beginning health care work or studies.MethodsRetrospective cohort study. We reviewed the charts of all new health care students and workers referred to the Montreal Chest Institute in 2006 for positive baseline tuberculin skin tests (≥10 mm). Health care workers and students evaluated for reasons other than positive baseline test results were excluded.Results630 health care students and workers were evaluated. 546 (87%) were foreign-born, and 443 (70%) reported previous Bacille Calmette-Guérin (BCG) vaccination. 420 (67%) were discharged after their first evaluation without further treatment. 210 (33%) were recommended treatment for latent TB infection, of whom 165 (79%) began it; of these, 115 (70%) completed adequate treatment with isoniazid or rifampin. Treatment discontinuation or interruption occurred in a third of treated subjects, and most often reflected loss to follow-up, or abdominal discomfort. No worker or student had active TB.ConclusionsOnly a small proportion of health care workers and students with positive baseline tuberculin tests were eligible for, and completed treatment for latent TB infection. We discuss recommendations for improving the referral process, so as to better target workers and students who require specialist evaluation and treatment for latent TB infection. Treatment adherence also needs improvement.

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Section: Discussionmentioning

confidence: 99%

Referrals for positive tuberculin tests in new health care workers and students: a retrospective cohort study

Schwartzman

2010

BMC Public Health

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“…Nevertheless, compared with developed countries where costs of maintaining a TST program are not trivial and may exceed that of the interferon-g assay[65], limited financial resources remain a major obstacle to the widespread use of this test in developing nations. Further studies are needed to establish the sensitivity and specificity of these tests at multiple geographic locations among patients of different ethnicities.…”

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confidence: 99%

Utility of the antigen-specific interferon-?? assay for the management of tuberculosis

Dheda

Udwadia²,

Huggett³

et al. 2005

Current Opinion in Pulmonary Medicine

108

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Compared with the tuberculin skin test, the antigen-specific interferon-gamma assay, when used in a standardised protocol (overnight incubation assay using a combination of two antigens) for the diagnosis of LTBI, has greater specificity in BCG-vaccinated individuals, displays a stronger association with exposure, and is less biased by environmental mycobacteria such as Mycobacterium avium. Prospective studies are required, however, to confirm that treating LTBI, as defined by the interferon-gamma assay, will reduce the tuberculosis burden in low-prevalence countries and whether interferon-gamma responses are predictive of those who have a high risk of progression to active tuberculosis. Further studies are required to address the utility of the interferon-gamma assay in specialised subgroups of patients, in developing countries, and as a marker of disease activity.

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“…Using the T-SPOT resulted in a cost per employee of $47.02. Other investigators have estimated the cost of a TST (placed and read in an occupational health department) to range from $55 to $164 per employee in 2011 dollars (King, 2013;Lambert et al, 2003). Shah et al (2012) analyzed implementation of the IGRA in a public health setting.…”

Section: Discussionmentioning

confidence: 99%

Tuberculosis Screening of New Hospital Employees

Foster-Chang¹,

Manning²,

Chandler³

2014

Workplace Health Saf

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Selection of the most suitable test(s) for detection of Mycobacterium tuberculosis (TB) infection should be based on purpose, setting, effectiveness, and cost. Two tests are available to screen for latent TB: the tuberculin skin test (TST) and the more recent interferon-gamma release assays (IGRAs). Based on the administrative, logistic, and technical ease of use, an IGRA trial was initiated by the occupational health department at an urban Veteran's Administration health care facility for TB screening of new employees. As a result, new employees completing the pre-placement process within the organization's designated 14 days increased from 77% to 97%, new employee clearance to work time decreased from 13.18 to 5.91 days, and new employee TB screening costs were reduced by 40%. The IGRA is an acceptable alternative to the TST and has significant potential to improve the process of pre-placement TB screening.

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Costs of Implementing and Maintaining a Tuberculin Skin Test Program in Hospitals and Health Departments

Cited by 27 publications

References 9 publications

Referrals for positive tuberculin tests in new health care workers and students: a retrospective cohort study

Referrals for positive tuberculin tests in new health care workers and students: a retrospective cohort study

Utility of the antigen-specific interferon-?? assay for the management of tuberculosis

Tuberculosis Screening of New Hospital Employees

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