TB/PPD testing

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emtcsmith

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Hey so I'm looking for some information beyond what google/wikipedia tells you about TB and PPD testing. I have a basic understanding of TB, its diagnosis and some about treatment but how common is it for a health care worker to get an exposure and things like that.

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undertow

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damn, i was just researching this myself today. I'm a pharmacy tech and i talked to this guy who's taking isoniazid about his medication. After the convo, the pharmacists tells me not to get too close to people taking that drug cause they have TB and its really contagious. He didnt cough or spit on me so i hope to damn i dont have TB.
 

vesper9

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i doubt that guy would be walking around with active TB

A few years ago when I started working at a hospital I had a positive PPD indicating exposure to TB. The xray showed no TB but I did have a small granuloma in my lung. I took Isoniazid for 6 months to clear it up just in case it contained TB that might activate one day.

Before going on isoniazid I talked to a the doctors I work for/alongside and found that a number of them or their colleagues had to do a 6-month isoniazid therapy often while in medical school or residency. None had devloped active TB, but I think exposure is pretty common (or maybe WAS more common b/c these doctors are older?)
 
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emtcsmith

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my own thinking would be that it would be sort of common but if anyone has stats that would be great. Oh and no I highly doubt a health care worker with active TB would be working.
 
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deleted87716

emtcsmith said:
how common is it for a health care worker to get an exposure

Not as common as you might think.

Source.

Healthcare workers represent the largest group of TB-exposed workers, and in the early years of TB recordkeeping, they were more likely than other workers to develop TB. As the Society for Healthcare Epidemiologists of America (SHEA) noted, more recent data indicate that healthcare workers "represent a small proportion of all cases and are not disproportionately represented in the TB caseload compared to their presence in the workforce". IOM reported that for 1998, although healthcare workers accounted for 9% of the working population of the U.S., these workers accounted for only 8% of TB cases among the working population, which does not appear consistent with these workers being at much higher risk of infection than the rest of the population. Moreover, from 1994 to 1998, the TB rate for health care workers declined almost 20%, from 5.6 to 4.6 per 100,000 population, while the rate for other workers remained steady at 5.2 per 100,000.

Because TB rates among healthcare workers vary demographically in a manner similar to rates among the general population, and because it is very difficult to determine whether any individual case was transmitted occupationally, many participants believed that much of the risk to these workers likely arises outside of work. For example, the Infectious Disease Society of America pointed to data "suggest[ing] that community exposure was responsible for most conversions even at a hospital which cares for a large number of TB patients." IOM pointed out that foreign-born workers account for a very high percentage of TB cases in healthcare workers. Many of these workers are from countries such as India and the Philippines, which have very high TB rates.
 

emtcsmith

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The chest xray is the defitive diagnosis test then right?
 

kate_g

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vesper9 said:
i doubt that guy would be walking around with active TB
You might be surprised... I worked for a critical care/pulmonary doc in a VA hospital. He had a patient who came in repeatedly with a nasty (productive) cough they couldn't get to clear up. After a while they finally test and discover he's got active TB. After that, they discover he hasn't got a car and he'd been taking the subway and bus to get to his appointments at the VA hospital... This was pre-SARS so they hadn't given him a mask when he first came in with a cough of unknown origin or anything. Of course they sent him home with a mask when they found out he had TB and still needed to take the subway home, but what are the chances he was actually compliant with that for the entire course of his treatment?

Needless to say, lots of docs and employees in VA hospitals come up positive for exposure with the TB skin test.
 

undertow

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we're all gonna die.
 

lpressley130

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I have worked as a registered respiratory therapist for several years and have had colleagues who presented with positive PPDs over the years (as well). I have read accounts of using UV lights in ERs (because that's where the patients usually show up first with their cough) to kill the TB while its airborne to using negative ventilation rooms after they are admitted. The big problem, as stated in a previous post, is getting to the point of making the diagnosis. I worked at a hospital where we would get memos from our infection control department stating, "...if anyone came in contact with or treated Patient John Doe on the following dates (of his admission) please report to IC. The patient was found to have TB..." I hated those memos. I don't have a positive PPD though. If someone was positive, they were prescribed a course of isoniazid right away and monitored for a period of time.
 

OSUdoc08

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emtcsmith said:
The chest xray is the defitive diagnosis test then right?

No.

A chest x-ray can rule out active TB disease, but it cannot exclude other possible causes of a pulmonary consolidation, granuloma, and/or other manifestations.

The diagnosis is made with identification of organisms by histological staining and/or microbiological culture. Molecular biology techniques, such as nucleic acid identification is also possible.
 

emtcsmith

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whats is the percent of false positives with ppd tests?
 

DNP student

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Most of my friends who have been in nursing for more than 10-15 years have pos PPD. Exposure to TB is very common in healthcare workers. However, it usually does not become active except in periods of severe stress in which the immune system becomes depressed. The biggest problem with TB today is that there are some resistant strains. If you get a pos PPD but do not have a productive cough, I wouldn't get too worked up.
 

Llenroc

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Don't be a *****. Something like half the world's people have some TB in their lungs, and they walk around doing just fine for the most part. I probably have some, although my PPD tests have been negative. :laugh:
 

JourneyRn-MD

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I have been exposed once already in the two years I have been working on my stepdown unit. Scared the beejesus out of me: took care of a young woman in close proximity over multiple days, a month later I get a letter in my mailbox that later on it had been discovered she had active TB and anyone involved in her care needed to be cleared. All of us exposed had follow up PPDs and chest x-rays. Everytime I coughed I thought I had TB until everything came back ok : )
 
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