Can I be fired for refusing PPD during pregnancy?

Nurses General Nursing

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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.

Specializes in ICU, LTACH, Internal Medicine.

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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Specializes in ICU.

My hospital no longer does PPDs- they've chosen to do a Quantiferon blood test on every employee annually. Overkill if you ask me, but more accurate I suppose. I'm sure you would be fine doing that, just know that the Quantiferon is more expensive so the hospital may ask you to do it at your own expense.

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Specializes in Urgent Care, Oncology.

I have seen false PPD positives on pregnant women so I'd hate for you to go through the process of having a false positive and the subsequent tests. It hasn't been a lot, probably 2-3 in the thousands that I have administered and read. Ask for the Quantiferon, I haven't seen it give a false positive on a pregnant woman yet.

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My hospital no longer does PPDs- they've chosen to do a Quantiferon blood test on every employee annually. Overkill if you ask me, but more accurate I suppose. I'm sure you would be fine doing that, just know that the Quantiferon is more expensive so the hospital may ask you to do it at your own expense.

My PCP in nursing school refused to do PPD tests anymore. Stated that they were inaccurate and he would only use the blood test. I received a bill from the lab for close to $500 in 2015.

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Specializes in School Nursing, Pediatrics.

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

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Specializes in Hospice, corrections, psychiatry, rehab, LTC.
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.

Mine does, and we do annual retesting.

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I will be asking him about this tomorrow. Thanks!

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Specializes in Psych, Geriatrics.

I also suggest the blood test. The results are done when they're done and don't require some subjective glance or measuring or prodding to interpret. The test itself is harmless, blood draw any time of day. Finding a lab to do it...that is a bit more tricky, they have to have a special test kit just for the test on hand and it has to reach a certain lab in a certain timeframe or results can come back invalid.

I've done these for 6 years now because I don't do PPD anymore - mild allergy to something in the serum, probably the preservatives, that confuses the interpreter of the test anyway.

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Specializes in ICU.

our facility switched to the quantiferon gold test. We don't do PPD anymore. I see no reason they could not accommodate you for that.

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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.

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At my facility paying for your own quantiferon out of pocket is $75. $500 seems like a lot, but that is the only comparison I have.

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Specializes in Adult Internal Medicine.

The QFT-G test has a retail cost of $65-75. Not sure why a PP would have been billed $500 unless that also included a lab draw for all the other immunization titres perhaps.

Did you OB want to screen you for TB during pregnancy? Do you work in corrections nursing or a nursing home?

Good luck with your pregnancy, having been through numerous with my wife, it is a horrendous trauma to have to endure. Sending you thoughts and prayers on your fetal heart rate tomorrow.

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