Tuberculosis Screening in the Long-term Care Setting

Abstract

Tuberculosis (TB) skin-testing practices in long-term care facilities (LTCFs) in North Carolina (NC) were assessed from a 56% (148/263) response to a comprehensive TB screening questionnaire. TB skin tests were administered to employees on initial employment by 98% and annually by 97% of the LTCFs, generally (74%) by the Mantoux method. Employee skin tests were read at the appropriate time interval of 48 to 72 hours by 91%, but less than half used diameter of induration when interpreting reactive tests. The booster test was performed on new employees at eight (6%) of the LTCFs. TB skin tests were routinely performed on newly admitted residents by 56% or conditionally required by 18%, generally (73%) by the Mantoux method. Resident skin tests were read at the appropriate time interval of 48 to 72 hours by 92%, but again only half correctly interpreted reactive tests as significant. Residents received routine annual skin tests at 71% of the LTCFs, generally (80%) by the Mantoux method. Eight (6%) facilities routinely performed the booster test on newly admitted residents. TB infection prevalence in new employees during 1983 was 8.1% (47/578) in seven LTCFs and in newly admitted residents was 6.4% (7/110) in three LTCFs supplying this data. The five-year mean TB skin test conversion rate among employees was 1.1% (101/9545) in 12 LTCFs and among residents was 0.9% (46/5216) in nine LTCFs supplying this data. Lack of compliance to established TB skin-testing guidelines in NC LTCF was prevalent. In recognition of described endemic and epidemic spread of TB in LTCFs, residents and employees of LTCFs should be screened for TB utilizing established skin-testing practices.

Utilidad del Quantiferon-TB Gold in Tube® en el cribado de la infección latente tuberculosa en personal sanitario

“…El personal sanitario, según las recomendaciones de la OMS, debe seguir controles periódicos de detección de la infección latente tuberculosa (ILT), con el objetivo de realizar un diagnóstico precoz y descartar enfermedad activa [9][10][11] . En el Hospital Universitari Mútua Terrassa (HUMT) se realiza el cribado de ILT mediante la prueba de la tuberculina (PT) a todo trabajador sanitario en el estudio de salud inicial.…”

Skin Tests for Tuberculosis

“…1 Certainly if there had been no significant outbreaks of tuberculosis in LTCFs in North Carolina for the last five years, it might be argued r . that elaborate programs for tuberculosis control might be superfluous and the effort involved better diverted to some other high priority areas.…”

An evaluation of tuberculosis skin test screening program in British Columbia long-term care facilities

“…TB infection rate of 21 .9% among British Columbia LTCF employees is in the mid-range of the 4.6-47% reported in the literature (Barry, 1987;Bass, 1981 ;Brennen, 1988;Gross, 1986;Halperin, 1992;Price, 1987;Rosenberg et al, 1993 ;Simon, 1983;Thompson et al, 1979;Valenti, 1982;Welty, 1985). This wide range of reported TB infection rates is related to variance in ethnic composition, age and gender in the population screened and to the methods of screening used.…”

“…The relative risk of TB in foreign born employees to foreign born community individuals, First Nations employees to First Nations community individuals and Canadian born employees to Canadian born community individuals are 0.88, 3.26 and 1.07, respectively. These results also indicate that TB is more related to the country of birth rather than place of employment (Ashley, 1971 ;Berman, 1981 ;Price, 1987).…”

“…Burrill et al (1985) found that the TB incidence among nurses born in Asia was 12 times greater than other Canadian born nurses. It appears that the occurrence of the disease has more to do with the prevalence of TB in the country of origin than the place of current employment (Ashley, 1971 ;Berman, 1981 ;Price, 1987).…”