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Positive PPD and nursing

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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?

roser13, ASN, RN

Specializes in Med/Surg, Ortho, ASC. Has 17 years experience.

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.

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.

KelRN215, BSN, RN

Specializes in Pedi. Has 10 years experience.

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.

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.

firstinfamily, RN

Has 33 years experience.

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.

amoLucia

Specializes in 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!!!

KatieMI, BSN, MSN, RN

Specializes in ICU, LTACH, Internal Medicine. Has 7 years experience.

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.

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).

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

Edited by Loo17

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.

amoLucia

Specializes in LTC.

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

meanmaryjean, DNP, RN

Specializes in NICU, ICU, PICU, Academia. Has 40 years experience.

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

I sure wish they did- because I think the intrademal hurts like a mother!

Farawyn

Has 25 years experience.

OP, always have the documented positive PPD ad the INH documentation with you when you go for a new job or school. You may have to have an occasional chest x ray even with the documentation, but the blood work another poster mentioned is always an option, then put *that* result with your other documentation and tell everyone NO PPDs.

Thank you everyone! So glad I have found this site for the support and knowledge I need. CXR was negative as usual and Im currently trying to track down the doctor that was caring for me during the INH. That was almost ten years ago and in a different town, so its been a challenge. Have a Merry Christmas!

TheCommuter, BSN, RN

Specializes in Case mgmt., rehab, (CRRN), LTC & psych. Has 14 years experience.

My tuberculin skin tests started yielding positive results back in late 2008, but I'm still employable because my chest xray indicates no active TB disease.

By the way, I do not need yearly chest xrays. My employer requires a chest xray for workers in my situation once every five years.

I wouldn't worry about what patient exposed you. My favorite ID doc says that if you ever rode public transportation you've been exposed to and infected with TB. :) If you have a normal immune system, and it wasn't the wildly virulent and drug-resistant type, you're always going to have the antibodies (that's what they're for and where they came from).

I went from no response every year to a humongous big concentric circle array that extended almost from wrist to elbow and itched like fury for two weeks. Fabulous immune system, that's me-- actually, a bit too fabulous, as events of subsequent years have testified to. No more PPDs for me :)