Can I be fired for refusing PPD during pregnancy?

  1. I am six weeks pregnant and due for my annual ppd test at work. I have a history of miscarriage and have been doing research on the safety of ppd tests in the first trimester. Sadly, not a lot of studies have been done.

    I believe I have a greater chance of having a negative reaction to the ppd than I do having it detect any tb exposure. I have had weird flushing/hot flash reactions to it in the past. In other words, I do not feel the benefits outweigh the risks at this point in time.

    Obviously, I will also refuse the CXR too.

    I am in CA. I work for a govt agency and am represented by a union.

    Do I risk my job if I refuse? Has anyone been in a similar situation?

    Thank you.
    Last edit by Brian S. on Oct 4
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  2. 31 Comments

  3. by   bagladyrn
    There is a blood test called Quantiferon Gold which is an alternative test to the ppd. Why don't you see if your agency will accept that?
  4. by   RN/Mom
    Never heard of that, thank you! I will look into it
  5. by   MunoRN
    Your employer is free to terminate your employment for refusing to meet their requirements, particularly since there is no evidence to support a claim they are asking you to do something unsafe. At the same time, I haven't heard of any employers that still use PPDs since it's not a particularly useful way of screening caregivers.

    While there haven't been large scale RCT's on the use of PPD's in pregnant women, it's important to understand the basis of why studies are done, and not done.

    There are no studies for instance that establish it is safer to jump out of an airplane with a parachute compared to without, that doesn't mean it's just as safe to jump out of an airplane without a parachute. Similarly, there's no reason to believe a PPD is dangerous for a fetus, and therefore there are no studies to refer to either way.
  6. by   Penelope_Pitstop
    Quote from MunoRN
    At the same time, I haven't heard of any employers that still use PPDs since it's not a particularly useful way of screening caregivers..
    Interesting...every employer I've had requires an annual PPD. I wonder if this is perhaps a regional thing?

    Also, as a side note, I'm currently 39 weeks pregnant and my OB's office administered a PPD when I was 11 weeks.
  7. by   Sour Lemon
    I had the same concerns and the same history (multiple). I only had a PPD with my first successful live birth.
  8. by   Sour Lemon
    Quote from Penelope_Pitstop
    Interesting...every employer I've had requires an annual PPD.
    Mine too.
  9. by   morte
    Quote from MunoRN
    Your employer is free to terminate your employment for refusing to meet their requirements, particularly since there is no evidence to support a claim they are asking you to do something unsafe. At the same time, I haven't heard of any employers that still use PPDs since it's not a particularly useful way of screening caregivers.

    While there haven't been large scale RCT's on the use of PPD's in pregnant women, it's important to understand the basis of why studies are done, and not done.

    There are no studies for instance that establish it is safer to jump out of an airplane with a parachute compared to without, that doesn't mean it's just as safe to jump out of an airplane without a parachute. Similarly, there's no reason to believe a PPD is dangerous for a fetus, and therefore there are no studies to refer to either way.
    what do they do instead?
  10. by   PixieRN1
    My employer uses the blood test listed above exclusively, never the PPD. Ask to have that instead since you are concerned. It’s better than the PPD, ergo no reason to go down over this one.

    Good luck on your pregnancy.
  11. by   klone
    Quote from morte
    what do they do instead?
    If they're smart, they use a parachute.

    What do who do instead of what?
  12. by   dream'n
    Quote from morte
    what do they do instead?
    A recent large hospital system I worked for did not do annual PPD tests any longer. Nothing else took its place. I just assumed that evidence based research showed that it was no longer necessary and it wasn't required by some law? I'll try and get time to contact their Employee Health department tomorrow and ask why if someone wants to know.
  13. by   klone
    A lot of facilities are no longer doing annual TB testing for low-risk areas of nursing.

    CDC | TB | Testing & Diagnosis | Testing Health Care Workers

    https://www.cdc.gov/tb/publications/...ixb_092706.pdf
  14. by   KatieMI
    Pregnancy is a naturally T-deficient condition, so in theory the probability of PPD false negative result might be increased, especially at late term. Ask for Quantiferon, and relax.

    I actually wonder why in the country which is supposed to be a beacon of progress in medical science and where so many people are chronically immunosupressed (every patient who takes an equivalent of 15 mg of prednisone orally/24h for more than 1 month, everybody with bone marrow suppression caused by any cause including chronic diseases such as CKD IV - V, everybody taking bone marrow supressors like methotrexate, everybody taking certain biologicals for IBD, psoriasis, lupus, etc, etc.) a test which is so unreliable as PPD is still practiced at all. It is cheap, it brings up $$$ because of two visits needed and it is "tried and true" (while not implying reliability and high quality), but I just cannot see why it should be still on board when we have Quantiferon. Quanti depends on peripheral B-cells function, which is notoriously difficult to supress.

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