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Looks like I may have a positive PPD for the first time and I'm supposed to be starting residency in July. What happens then? Will I be able to start on time? Thanks.
Thanks for your response. I had no known exposures over the past year, no travel, and have not had BCG vaccine (always been negative before). I assume I won't be actually prevented from starting residency because of this? Also, are healthcare workers required to take INH to keep working?
I think all you need is that cxr. you don't need to take INH if your cxr is negative and you will be good to go. If the cxr is +, you likely have latent TB--so then take INH for 9 months of course. I think they may still let you work, but im not sure. you would have to contact your program to see if they will let you work. If you have positive sputum for AFB then you should be worried and put in isolation, but i dont think that is the case. not to mention you still have to get that second PPD for confirmation. good luck!
You might want to review the diagnosis and Tx of LTBI.
Pt's (new converter's) with a positive skin test (5/10/15mm induration, this varies depending on your risk status, HIV, which country you come from, etc., we memorized this for step1,2) undergo clinical evaluation to rule out active disease, physical exam and chest xray. If these are negative (ie. no active disease), then they are treated with INH x9 months because they have LTBI infection and are at risk for reactivation infection. Additionally, you can work with patient's while being treated for LTBI.
Even if you had the BCG in the past especially if it was as a child, you are still prone to get latent TB, and thus you still have to take the INH.
The end part of your sentence is no longer correct.
Seems like there would be time for you to start medication and become noncontagious, if it comes to that.
It happens. One of my med school classmates got TB during surgery residency. It wasn't found on routine PPD, but he developed a persistent cough and it was found as a result of that. If I recall, he was out for two weeks to start meds and then back to work. It wasn't a huge issue.
Is it common for a seemingly +ppd at 12 hours to be read as negative at 48-72 hr?
Don't sweat it yet, this happens to me EVERY time I get a ppd. I am red and swollen for the first day, and the next day its gone.
"Red and swollen" i.e. erythema do not indicate positivity, even at 48-72h. There is a palpable area of induration (if you do not know what that word means, please look it up, so many people just conflate the term with erythema). There is a whole lot of misinformation being propagated on this thread regarding this test - I would not really trust a nurse to read or interpret this test unless specifically trained to do so.
As for "where do you get these guidelines, they seem to be changing all the time!", please check the CDC website.
Many places have started using the Quantiferon Gold test, which I feel should become the standard since even physicians (as evidenced here) still have tenuous knowledge about the PPD.
Not sure why you are quoting me saying that the guidelines change all the time. I never said that.
This was not meant to start any debate, don't turn it into one. MD's and RN's alike who have never seen positive PPD's make the mistake of calling it positive if it isn't. Some facilities don't allow any MD other than pulmonologists to read them because of this.
I know how to read a PPD and I understand what induration means. Swelling and erythema can look and feel like induration, and until that 72 hours pass, it can be misinterpreted. I was under the impression from the OP that the student was reading his/her own at 12 hours. The OP was concerned about internship being delayed due to a "positive" PPD. I was trying to assure him/her that other people have similar looking PPD's that don't turn out positive and not to worry about it until they get there.
Sorry, I was lazy, and the "guidelines" part was meant for another poster who had commented on that. I didn't want to make two posts. Please provide examples where "only" pulmonologists are allowed to read PPD's, I strongly disbelieve you and feel that this is another example of nurses citing rules which don't exist. For one, it would be laughable if such a facility did not "allow" a pathologist (i.e. the people responsible for laboratory medicine) to read the test, as this is essentially a medical test (not to mention the exemplar for the Type IV hypersensitivity reaction). Every physician should know how to interpret a positive PPD, as this is expected of us on all our licensure exams. Also, how can something "look" like induration when induration is a quality observed on palpation? I do agree with you, though, that the original poster should wait some more time before freaking out.
To the OP,
I think it is best if you ask your workplace whether you can work or not and about when to take the meds, instead of asking on SDN. Your work place has their own rules, etc. and if they say it is positive, double check it with a pulmonologist to be sure.
Good luck!
It can feel like induration initially, until the initial reaction goes away. If the PPD was placed SQ accidentaly, it can form a hematoma that feels like induration. That happened to me. If you have someone who doesn't know what a + PPD looks like (no matter if that person is an RN or MD), they will mark you off as having a + PPD. I asked one of our pulmonologists to look at it, and if he agreed that it was not positive to please write me a note saying it was checked by him and not in fact +.
I'm making things up? Your gonna feel pretty stupid when I prove you wrong. My friend is a travel nurse who has worked all over NYC for the past few years and one hospital she worked at required all new employees to have the PPD checked by a pulmonologist only. I believe it was Bellevue, but I will find out for sure and update this post when I find out for sure. Then any residents on here can verify that this is true and not just "nurses" making things up.
Not only do I not feel stupid, I don't anticipate feeling that way either - at the very least because I know the difference between "your" and "you're". I believe all the hospitals in the HHS system, yes, including Bellevue, use the Quantiferon Gold test, at least they do for outside physician and student rotators. Furthermore, all physicians should know how to interpret a PPD and know what induration is and contrast it from erythema; your point about RN vs MD is irrelevant as this is a basic skill that all physicians should possess. Your point about time delay is also a given, since the very first chapter of every physician's course in pathology deals with delayed-type (IV) hypersensitivity: even if a physician had never seen a +PPD, by history alone, s/he should be able to rule out any sort of immediate reaction as positive due to pure basic science. Please post an official policy if you ever manage to get one.