Can I be fired for refusing PPD during pregnancy?

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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.

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Specializes in OB.

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?

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Never heard of that, thank you! I will look into it

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Specializes in Critical Care.

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.

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Specializes in Medsurg/ICU, Mental Health, Home Health.
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.

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I had the same concerns and the same history (multiple). I only had a PPD with my first successful live birth.

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Interesting...every employer I've had requires an annual PPD.

Mine too.

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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?

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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.

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Specializes in Nurse Leader specializing in Labor & Delivery.
what do they do instead?

If they're smart, they use a parachute.

What do who do instead of what?

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Specializes in UR/PA, Hematology/Oncology, Med Surg, Psych.
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.

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Specializes in Nurse Leader specializing in Labor & Delivery.

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/guidelines/pdf/appendixb_092706.pdf

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