Positive TB Skin Test - Please, need advice!

RoxanRN · Apr 15, 2005

A young woman who works in our nursing department, newly hired, had a positive TB skin test this week. She just had a TB skin test 6 months ago and it was negative. She had an xray done, and the radiologist called back and wanted to know if she was a smoker, because at 20 years old, her xray looked bad to him. (?) We know that the Infection Control nurse had her go to the health department, and they are putting her on 6 months of medication.
No one in our department has informed me of any risk to myself or the other staff....but if they're treating her with meds for 6 months, this makes me wonder. Has anyone else had any experience with this in the workplace? Please reply soon, as several of us are concerned!

I would think Risk Management would have everyone she was in prolonged close contact with test. It's just like an exposure from a patient.

nursypoo · Apr 16, 2005

First of all, why did the radiologist disclose that info about her chest x-ray? That is confidential. Second, just b/c she's on medication for 6 mths doesn't mean that she is contagious. It could just mean that she was exposed to tb.

BadBird, BSN, RN · Apr 16, 2005

I converted 8 yrs. ago from a patient that no one knew had TB, as a matter of fact 5 RN's had positive tests. The standard is a chest xray, and counseling with a infectious disease Dr. I was offered 6 months of meds, but after considering the side effects of the meds I chose not to take them. I am lucky and have never had a problem. The health dept. only required a yearly CXR if you have symptoms. My advise is to not panic, weigh your options carefully and if you choose the meds get monthly lab tests to check for liver damage.

Trauma Columnist · Apr 16, 2005

A positive PPD (TB skin test) simply means that at some point, you were exposed to TB. It does not mean you have active TB nor that you can pass it on. I've lived several places where TB is endemic (Alaska and Korea) and it is actually rather difficult to get TB unless you have prolonged exposure.

rjflyn, ASN, RN · Apr 16, 2005

From looking at the original post I dont see where the radiologist disclosed anything- maybe the nurse who is involved did, its just jumping to a conclusion by making that statement with the info provided.

As far as others needing treatment typically that takes place on a case by case basis. Also all a positve TB test shows is that one has at some point in time became exposed. A "bad" chest xray yes is suspicious for TB but with the info provided one cant really make any conclusions. Also when some one tests positive for TB for the first time it is routine to treat them with antibiotics for 6 months at a minimum. Believe me when I say to the poster who is concerned about her self and other coworkers of this nurse. If anyone in infection control had any concern that you may be at risk you who have been tested long before now- the hospitals I have worked in tend to go in to overkill mode when this happens and they test everyone and I mean everyone down to the janitor who might have walked throught the dept.

rj :cool:

First of all, why did the radiologist disclose that info about her chest x-ray? That is confidential. Second, just b/c she's on medication for 6 mths doesn't mean that she is contagious. It could just mean that she was exposed to tb.

anndoodle · Apr 16, 2005

The radiologist told the girl, herself - he called her to ask if she was a smoker, and she told him no - that's when he made the comment about her xray looking "bad". The girl then told some of the other staff what was going on, and that's how we knew about it.

NurseNat · Apr 16, 2005

:specs: Here's what I remember from working Public Health (keep in mind this is from Canada).

Positive TB skin test (aka Mantoux test or Tuberculin test) means you have been exposed to TB, that's all. If you have a previous negative, the exposure probably happened sometime in the time frame between the tests.

The next step is to ascertain if you are symptomatic (weight loss, productive, persistent cough, hemoptysis, night sweats...). If productive cough, then you would send the sputums samples off for culture. Usually chest x-rays are done as well (even if you aren't symptomatic).

For the most part, to be infectious, you are more than likely sick...not at all up to work. The most infectious type of patient is "smear positive", they are usually hospitalized and treated until the sputum comes back negative. That's when contact F/U is inititated.

It is possible for a person with a positive mantoux and suspicious chest x-ray to be non-infectious. Each TB specialist is different, but most put people on the 6 month INH protocol to be safe. But some docs won't if they at all sense you will not be compliant (resistent strains are getting common).

Hope that makes sense! :)