Should I retest a patient with a positive PPD history?

[Thomas RN]

i am concerned that the nurses at my workplace are being given the incorrect information about placing a ppd tuberculin skin test on patient that says the he/she has a positive ppd history. my place of employment is very small and only has only four full-time rn's and three per-diem rn's. i am one of the three per-diem rn's/ we do not have a director of nursing and there is no written policy or procedure in place for how to correctly care for a patient that arrives at the facility telling the nurse that they have had a positive ppd test for tuberculosis and a chest x-ray wast taken and the results showed that this patient was negative for any respiratory disease. we were not able to fax a release of information and a request for medical records. i arranged for that patient to have a chest x-ray because of a positive ppd history. i was told that i had done the wrong thing. i was told that i should have repeated the ppd skin test regardless of what the patient had said about his or her ppd skin test history. taught that once an individual has had a positive ppd skin test, the skin test should never be repeated because of the possibility of a severe reaction including, blistering of the skin, infection of the skin, necrosis etc. is it not the usual practice to order a chest x-ray or ask the licensed physician or apn or pa to order one. isn't this a liability issue as well. could not the facility be sued if a severe reaction occurred? a co-worker and i have decided that if told to repeat a ppd skin test on a patient that states that he/she has had a positive reaction in the past, we simply must refuse because this could cause harm to a patient and be a violation of the nurse practice act? thank you thomas rn.

[dishes, BSN, RN]

You can research this with your local health department and the CDC websites.

[xtxrn, ASN, RN]

I was always told to never give a PPD to someone with a history of positive results, and get the CXR. :)

[JustBeachyNurse, LPN]

In school we were taught to administer the PPD unless there is documented evidence of a previous positive reaction. I know even in nursing school some of us had allergic type reactions but no induration. Some thought that meant they could never again have a PPD test due to the redness and itching. (Mistakenly thinking that ANY reaction means no more PPD)

The health department came to school and explained the current guidelines for PPD, Chest x-ray, or the blood test for TB screening. (All consistent with the current CDC guidelines of course)

Check with your local health department or the CDC for the current guidelines and recommendations for PPD testing.

[ChristineN, BSN, RN]

In school we were taught to administer the PPD unless there is documented evidence of a previous positive reaction. I know even in nursing school some of us had allergic type reactions but no induration. Some thought that meant they could never again have a PPD test due to the redness and itching. (Mistakenly thinking that ANY reaction means no more PPD)

The health department came to school and explained the current guidelines for PPD, Chest x-ray, or the blood test for TB screening. (All consistent with the current CDC guidelines of course)

Check with your local health department or the CDC for the current guidelines and recommendations for PPD testing.

I think you are over-analyzing the "documented" part. Alot of pt's that I seewith a history of a positive PPD are from South America and Asia, and have no medical records or limited medical records in the United States. Does this mean when these people immigrate they should have to be retested? I would not be comfortable administering a PPD to anyone that has a history of a truly positive PPD, documented or not.

[elkpark]

I've had a + PPD for decades. When the infection control nurse at a small rural hospital at which I worked many years ago insisted on giving me a PPD as part of my annual eval, even though I told her I was + and had been for a long time, my physician was furious and told me to never allow anyone to give me a PPD again (possible necrosis, sloughing, etc.)

I've worked for a lot of different employers over the decades, and no one (else) has ever hesitated to just take my word for it that I have a + hx, or wanted to give me the test anyway. For many years, everyone wanted an annual CXR, and then, more recently, they've gone to the weird little sx questionnaire.

[xtxrn, ASN, RN]

IMHO, if a facility won't do the CXR, they're looking at the cost to them, vs the risk to the patient with a + PPD history....

[Esme12, ASN, BSN, RN]

http://www.cdc.gov/tb/

I, too, have always been told never to repeat a Mantoux on a positive patient and I have heard the blistering, sloughing stories too. Although I have never seen it.......I had another MD tell me....Why do another Mantoux? it's positive! Just Do a CXR to see if they're active.

I'd have to check with the State Board of Health and CDC as well as the medical director of the facility.

[Nickymad1]

In my opinion and experience with dealing with the PPD skin test, you should NOT test again! I work for a hospital and our procedure mandates that after a positive result the chest x-ray is done wich is good for 2 years according to the CDC. If the X-ray is negative then no medication is administered. Between x-rays a questionaire is done to make sure no symptoms have risen to indicate infection. People that have recieved the BCG vaccine at a later point in life show a more severe reaction to the tb skin test. I have gotten BCG 3 times (its a long ridiculous story) and my reaction to the test three years ago was instant, with painful blistering so bad that my husband turned the car around to go back to the hospital for some medicine. I had a huge mark on my arm for 3-4 months.

I work in a NICU and my boss is very addamant about the tb testing for me and only requests an xray every 2 years if there are signs. There are also blood test that can be run that would be more conclusive than the skin test.

[RunnerRN2015, ASN, RN]

Interesting thread as I had a positive PPD about 19 years ago (although I really don't think it was positive....long story). My chest x-ray was clear and I was put on INH pills for 6 months (or 9 months....I can't remember). I was told never to bother with the PPD since, with the INH, I will always test positive. Don't know if that's actually true? I have a chest x-ray every 2-4 years as required for teaching, depending on the school.

[darkbeauty]

I've had a +PPD in 2002 a large,nast blister on my left forearm) that took almost half a year to heal. I've always had yearly CXRs to rule out active disease. I have refused getting a PPD since. Once I applied with a staffing agency and they demanded I get a PPD and get written documenation of a +PPD reaction. I refused adamantly, and that was the end of the application process. I figured in the PPD regard, I am my own's advocate!

[RunnerRN2015, ASN, RN]

Has anyone else with a positive PPD and negative chest xray have to take INH? I've heard from a few people who were positive and only require an annual chest xray. Any idea why my doctor put me in INH instead of just ordering an annual chest xray? I hope this won't be a problem for school; it's never been an issue with teaching.