Can I be fired for refusing PPD during pregnancy?

[RN/Mom]

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.

[shibaowner, MSN, RN, NP]

There should be no problem requesting the blood test instead of PPD. I cannot take a PPD because I was exposed to TB as a child and I will test positive on a PPD plus get a nasty rash. I never had TB nor am I contagious. No hospital has ever had a problem with giving me a blood test when I explain why I cannot take PPD.

[klone, MSN, RN]

Can you get a note form your OB saying it is against her medical advice at this time that you receive it?

But it's not. A PPD is not contraindicated during pregnancy. So I would be very concerned about any OB who would do so.

I think asking for a quantiferon, and paying for it out of pocket if necessary, would probably be the best option.

Good luck on the ultrasound tomorrow, OP!

[Kooky Korky, BSN, RN]

I have wondered if I have an allergy as well. Twice when receiving it, I have had a weird hot/flushing type reaction within a few minutes of receiving it. My skin never has any reaction at the test site though.

There is so much science doesn't understand about our immune systems and miscarriage, especially why some women (like myself) have recurrent miscarriages. It is scary to have my body injected with any foreign substances right now unless doing so offers a benefit that outweighs my risk of another miscarriage.

I should be finding out tomorrow whether my baby has a heartbeat. Going by my history, there is about a 60% chance it will be another missed miscarriage. If this is a viable pregnancy, I am going to do everything possible to protect my baby and keep it alive. Avoiding unnecessary exposures to substances that have not been proven safe is just instinctual to me.

If you have had previous reactions to being tested, please don't let them give you a PPD ever again, especially now that you are pregnant - but even if you weren't pregnant. I'm not an expert on allergy, but it sounds like you need to avoid PPD's. Period.

See what your OB has to say. Do nothing while pregnant that makes you uncomfortable or worried if you can possibly avoid it.

Just an aside - I don't know how strict your facility is about yearly TB tests, continuing education, recertifications, and the like. Some facilities are quite lax, it seems. I am not saying you should see if just keeping quiet about it until you get back from maternity leave, but I am wondering if anyone would even notice you were not in compliance. Just wondering.

Wishing you all the best.

[Oemgee, RN]

My hospital system has had an annual survey. It's s/s of TB and whether you've been exposed. I left and came back, they ran the blood test. The job I left for did the PPD. The bottom line is that there are options and you're within your rights to ask if they're available to you.

[Thanksforthedonuts, MSN, APRN]

At the first visit (once it has been established that there is a baby in there), most OBGYN/Midwives will order a blood draw with a basic panel among other things. It's usually then that I ask them to add on a quantiferon gold test. If they are taking your blood might as well only get poked once! I have never had a provider say no”... it's another screening method they can check off. Usually the quantiferon gold is valid for a longer period of time in some places so I just like to get it done. Most PPDs (where I have worked) were only considered valid for 1 year unless it was a 2step. When I applied to nursing school I had them add QG to my glucose screening lol. Just ask.

They only take blood you. Not inject anything.

I understand your concern. I get the same reaction with the MMR. I had a reaction once I received the vaccine after delivering baby #2. I was so exhausted I wasn't sure what I experienced. Sadly, about 3 years later I got a needle stick with MMR and has the same reaction again! Face flushing and tingling with the needle stick. Face/tongue was itchy and tingly when I got the full vaccine. I don't remember having any reaction to it as a kid... only as an adult. Obviously MMR is not given when your pregnant but if it WAS I would probably defer it until after the pregnancy out of precaution.

[CNSnurse]

Most hospitals in my area (Los Angeles, CA) do not use the PPD anymore due to false negatives. My current employer does the quantiferon gold (Q gold for short) blood test. its more accurate, but I have heard its much more expensive.

[Pepsimx5]

T-spot is a blood test that replaces need for PPD and is (I believe) more accurate.

[klone, MSN, RN]

T-spot is a blood test that replaces need for PPD and is (I believe) more accurate.

That is the same test as quantiferon