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Google Drive Update for TB Testing in Healthcare Workers Review of T-SPOT QuantiFERON vs Skin Testing
Dropbox Update for TB Testing in Healthcare Workers Review of T-SPOT QuantiFERON vs Skin Testing
In this blog post, we will provide an update on tuberculosis (TB) testing in healthcare workers. We will review the different tests available and discuss the pros and cons of each. Our guest for this discussion is Dr. Laura Radtke, a NAOHP Board Member and Adjunct Assistant Professor of Medicine and Medical Director at Froedtert Medical College of Wisconsin Occupational Health Services.
TB Testing and Healthcare Workers:
Dr. Larry Earl starts the conversation by introducing the topic and welcoming Dr. Laura Radtke to the discussion. They both recognize the increasing trend of healthcare systems switching over to blood tests for TB testing in healthcare workers. However, they also discuss the traditional TB skin testing process and the two-step procedure recommended for healthcare workers.
The Traditional TB Skin Testing Process:
Dr. Radtke explains that the typical TB skin test procedure involves injecting a small amount of fluid on the inner surface of the arm, resulting in a raised lump known as a “wheel.” The test is read by a trained healthcare worker 48 to 72 hours later. The size of the reaction is measured, taking into account the patient’s health status, history of exposure to tuberculosis, and prior testing results.
Two-Step Testing:
If healthcare workers haven’t had a TB test in quite some time, they may need to undergo a two-step testing process. This involves getting the initial test and then returning within 1 to 4 weeks to repeat the test. The second reading allows for the evaluation of a true response to the reagent. Dr. Radtke acknowledges that the two-step process can create scheduling challenges and adds to the burden for both healthcare workers and the providers administering the test.
Challenges of Skin Testing:
Dr. Radtke highlights several challenges associated with TB skin testing. These challenges include the need for patients to return for a second appointment in the correct timeframe, technical skill requirements for administering and interpreting the test, and the potential impact of the BCG vaccine on the test’s accuracy.
TB Blood Testing:
To address the challenges associated with skin testing, healthcare systems have turned to TB blood tests, also known as interferon-gamma release assays (IGRAs). Dr. Radtke explains that TB blood tests have several advantages over skin testing.
Advantages of TB Blood Testing:
One of the immediate advantages of TB blood testing is that it can be done without the need for multiple appointments. The blood test can be administered on any day of the week, and the results are typically available within 24 to 48 hours. Additionally, TB blood testing eliminates the need for a two-step procedure, making it a more convenient option for both healthcare workers and providers.
Accurate and Specific:
TB blood tests, such as QuantiFERON and T-SPOT, are highly specific for tuberculosis and have a higher predictive value for progression to active TB. Unlike skin testing, TB blood tests are not affected by prior administration of the BCG vaccine. This makes them more reliable in populations with a history of BCG vaccination, such as foreign-born individuals working in healthcare.
Cost-Effectiveness:
While TB blood tests may appear more expensive on the surface, studies have shown that they can be more cost-effective than skin testing when considering factors such as staff time, missed appointments, and the need for additional tests like chest X-rays. TB blood tests offer a faster turnaround time, allowing healthcare workers to begin their duties sooner and reducing the burden on employers waiting for new hires to start.
Transitioning to TB Blood Testing:
Dr. Radtke emphasizes that healthcare providers should consider transitioning to TB blood testing if they haven’t already done so. However, she mentions that there may be some selected situations, such as contained populations, where skin testing may still be appropriate. It is important to have a clear understanding of the benefits and selling points of TB blood testing when discussing it with clients.
In conclusion, TB blood testing has emerged as a more convenient, accurate, and cost-effective option for TB testing in healthcare workers. With the availability of tests such as QuantiFERON and T-SPOT, healthcare systems can streamline the testing process and provide reliable results in a shorter timeframe. By adopting TB blood testing, healthcare providers can enhance the efficiency of their screening programs, improve patient outcomes, and reduce the risk of tuberculosis transmission in healthcare settings.
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