Should We Abandon Routine TB Testing for Healthcare Workers?

It’s been a requirement for all my career. Is it still necessary?

A new report has revealed that tuberculosis (TB) has become so rare among healthcare workers that it is not worth the time and expense to do routine testing.  The report was published in the Center for Disease Control and Prevention’s Morbidity and Mortality Weekly Report.

We are performing tens of millions of TB tests annually on a population that does not have TB. Routine TB testing was generated by old fears of the infection which public health programs have been highly effective of abolishing. During 1915-1916 tuberculosis was incredibly dangerous and the leading cause of death. But 100 years later the progress in treatment and control has brought about a significant decrease in the occurrence.

Living conditions and improving diet have contributed to the United States having the lowest rates of TB infection workers. The report says that there was a 43 percent drop in individual rates from 2005 t0 2017. The report stated approximately 2.8 cases per 100,000 people. In healthcare workers the rate is even lower, 2.5 per 100,000 workers.

There are roughly 18 million healthcare workers in the United States and testing is a huge expense. Not only are we testing upon employment, but also testing annually. In our geographic area we are also doing significant testing in our public schools. Upon entry to first grade and again when moving from elementary to middle school or some districts are requiring it every 3 years,

The research contained in the report was based initially on more than 1,800 studies conducted since 2005. The most prominent studies show that 96.6 percent of annual TB tests on the workers (400,00) employed in VA hospitals are negative. Policy changes this major are hard to get implemented. To get an answer from our clients we did a survey and the questions and results are below. There were 626 healthcare workers who participated in this survey.

Of the 626 respondents 71% people reported they have never been exposed to TB in the last two years and 16% reported they have been exposed in the last two years.  Of the 626, 11% reported they have never been exposed to TB which is considerably lower than we anticipated.

With a 16% exposure rate, do you think it’s still necessary for facilities to test annually?  Whether we feel it’s necessary or not our survey stated that 67% of respondents facilities required TB screenings on an annual bases.  What was somewhat puzzling for us though is that only 13.9% reported that their facilities required TB screening for upon hire and 14% reported their facility did not require any pre-employment TB screening.

We had a large representation of respondents from urban areas at 80% and 20% in rural areas.

The new CDC recommendations, as of May 2019, have key changes added for screening including adding the individual baseline TB risk assessment and a recommendation for most healthcare personnel no testing unless there is occupational risk or ongoing exposure. The full recommendations are available on CDC’s website.


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