Positive PPD and nursing

Published

Hello all. I worked in healthcare for 8 years before going back to school to achieve my dream of becoming a nurse. One of my patients at some point during my career must've had active tb because I received my first positive pod test in 2005 (negative chest X-ray). I took the INH pills and went about my merry way. Now entering nursing school, I took my third ppd test and again it's showing positive (just barely each time I might add). What I'm wondering is.... Can I get turned away from nursing school or more importantly, will having inactive tb effect my chances at finding work after graduation?

Up Vote Up Vote ×
Specializes in Med/Surg, Ortho, ASC.

Your situation is very common. A negative CXR is all you need.

FWIW, you should not ever take the PPD again. It will always be positive. Just keep a copy of your negative CXR that addresses the issue of a positive PPD and speaks to that. In other words, the "indication" for the film should be "positive PPD" and the reading will address the absence of TB.

Up Vote Up Vote ×

Thank you roser13. Is there a particular reason why one should never take a tb test again after receiving a positive? I've been told that before and was never told why.

Up Vote Up Vote ×
Specializes in Pedi.
Thank you roser13. Is there a particular reason why one should never take a tb test again after receiving a positive? I've been told that before and was never told why.

Because once you have a positive PPD it will always be positive. It's a waste of time to do it when you know you will come up positive.

ETA, a positive PPD does NOT mean you have "inactive TB", it means you have been exposed to TB at some point in your life.

Up Vote Up Vote ×

I don't think that you can be turned away for a positive PPD.

PPD can diagnose an infection, but not the disease itself. Unless you get HIV or somehow immunocompromised, it's really unlikely to get the actual disease.

Up Vote Up Vote ×

Having a positive PPD should not impact your employability. You should refrain from having the PPD test and keep a copy of the CXR and when you are hired explain to the Occupational Health Nurse that you had a positive PPD in the past and therefore have the CXR results available. They may ask that you get a more recent CXR but, that would be up to them. It is true a positive PPD means you have been exposed not necessarily have had TB and you still need to protect yourself from it when you take care of patients.

Up Vote Up Vote ×
Specializes in retired LTC.
Thank you roser13. Is there a particular reason why one should never take a tb test again after receiving a positive? I've been told that before and was never told why.
roser13 is correct - do not repeat PPD injections. The injection site can blister-up and leave extensive scarring (scars). And I do mean EXTENSIVE!!!

Up Vote Up Vote ×
Specializes in ICU, LTACH, Internal Medicine.

1). No, your school cannot refuse you admission because of it. Neither can an employer, for the future reference.

2). The rule of thumb is "once positive PPD - always will be positive PPD", for whatever reason. Only one thing you'll have to do every year is chest Xray.

3). You should not ever agree for repeated PPD because the result will be (quite predictably) positive and because there is such thing as "systemic PPD reaction". It is a rather rare event and mostly happens with people with multiple exposures to Tb/BCG vaccine and pre-existing alterations of immune system but when it happens, it is really nasty. You also should not agree to Quantiferon Gold (blood test specific for exposure for Tb vs. BCG) because it most probably will be positive, too.

I would reach the doctor who prescribed you INH and/or cared for you at that time and ask him/her for a piece of paper stating that further PPD testing/Quantiferon Gold/whatever else is contraindicated for the reason of past contact with Tb/treatment. Your local County Public Health Department can also give you such paper if you give them paperwork regarding your past medical/Tb history. With this paper, you'll have your back covered.

P.S. "back to normal" PPD after IHN course is not a part of public health mythology; it really happens and was described in anecdotal clinical reports but the real frequency of this is unknown. So do not believe if someone will tell you to have PPD because you "must be clean" after completing your INH.

Up Vote Up Vote ×
1).

2). The rule of thumb is "once positive PPD - always will be positive PPD", for whatever reason. Only one thing you'll have to do every year is chest Xray.

The reason, simpy put, is that all the PPD is is a skin test to indicate whether the person having the test has been exposed to TB in the past...and therefore has some antibodies present in their system. The protein used in the PPD makes the body THINK it has ACTUAL tuberculosis bacteria inserted into the skin, and therefore creates a reaction. So.....you will always have this reaction, because you can't go back in time and UNexpose yourself :)

As for the annual CXRs, this isn't really the standard; it's more like every 2 unless symptoms are present (annual checkoff list is a good idea to SEE if you need a CXR).

Up Vote Up Vote ×

What Are False-Positive Reactions?

Some persons may react to the TST even though they are not infected with M. tuberculosis. The causes of these false-positive reactions may include, but are not limited to, the following:

Infection with nontuberculosis mycobacteria

Previous BCG vaccination

Incorrect method of TST administration

Incorrect interpretation of reaction

Incorrect bottle of antigen used

Who Can Receive a TST?

Most persons can receive a TST. TST is contraindicated only for persons who have had a severe reaction (e.g., necrosis, blistering, anaphylactic shock, or ulcerations) to a previous TST. It is not contraindicated for any other persons, including infants, children, pregnant women, persons who are HIV-infected, or persons who have been vaccinated with BCG.

http://www.cdc.gov/tb/publications/factsheets/testing/skintesting.htm

Up Vote Up Vote ×

There are also blood tests now you can opt for instead (Quantiferon-TB gold, T spot). This is what I do when requested so I don't have to get so many X Rays.

Up Vote Up Vote ×
Specializes in retired LTC.

Slightly off the subject but does anybody still do the old tine tests? Do they still make it anymore?

Up Vote Up Vote ×
+ Join the Discussion