Should I retest a patient with a positive PPD history?

Nurses General Nursing

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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.

Should be "on INH" not "in INH"......oops!

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Specializes in CCU,ICU,ER retired.

I test postive with a severe reaction (necrosis) and it to, took forever to heal. I had a new boss that insisted I get tested again even when I told her I can't. The hospital provided wound care for me. Anyway, The first time I had to take INH for 6 months along with B-12. I dont know why some doctors do and some don't.

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I worked with one of the country's best infectious disease specialists for a couple of years and he would always re-test a pt who reported a previous positive PPD, and if that was negative he'd order a second one straight away (two-step PPD).

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it's not the inh that makes your test positive, it's the antibodies your body made when it was challenged with the tb bacillus you inhaled.

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Specializes in Assisted Living Nurse Manager.
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.

In the state I live in anyone who test positive and even though they have a negative chest x-ray get treated unless they refuse. The way that I understand it if you are treated you should have less of a chance of ever converting to active TB.

I have always been told that there needs to be documentation of a positive TB or the person needs to be tested. However I am going to check with our health department tomorrow and get some clarification about this.

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I have always been told that there needs to be documentation of a positive TB or the person needs to be tested. However I am going to check with our health department tomorrow and get some clarification about this.

I don't have any of my documentation for the original test or the INH (back in 1992). I never bothered getting retested because I was told I would always test positive. There was always a question whether or not the PPD WAS positive--1 nurse said yes, a few others said no. Unfortunately, the one who said yes was the one who had to read the test. I've wondered if I should ge re-tested but I was told that the INH would make me always test positive. Maybe that's not the case after all.

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Specializes in Complex pedi to LTC/SA & now a manager.

There is a blood test that is conclusive and may be used in lieu of a previous (?potentially) positive PD reaction or BCG vaccination. If there is any doubt whether your previous test was positive, and you would rather not take a risk of a more serious reaction perhaps inquire about the blood test.

From the CDC website: "

TB blood tests

TB blood tests (also called interferon-gamma release assays or IGRAs) measure how the immune system reacts to the bacteria that cause TB. If your health care provider or local health department offers TB blood tests, only one visit is required to draw blood for the test. The QuantiFERON®-TB Gold In-Tube test (GFT-GIT) and T-SPOT®.TB test are two Food and Drug Administration approved TB blood tests. "

source: http://www.cdc.gov/tb/topic/testing/default.htm

There was an issue at a local facility (that unfortunately made headlines) about a potential TB exposure and "many staff positive PPD tests". It turned out that the individual "reading" the tests was not properly trained and was considering a redness or hive a positive reaction instead of an induration/induration size. A nightmare for the facility, staff, students who had clinical rotations at the site, visitors, patients, families and local health department.

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There was an issue at a local facility (that unfortunately made headlines) about a potential TB exposure and "many staff positive PPD tests". It turned out that the individual "reading" the tests was not properly trained and was considering a redness or hive a positive reaction instead of an induration/induration size. A nightmare for the facility, staff, students who had clinical rotations at the site, visitors, patients, families and local health department.

I swear this is what happened to me! I had several PPD tests before and this one didn't look any different from the others. The other nurses agreed--but they weren't the one assigned to read it. Grrrr!! Thanks for the information about the blood test!

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Specializes in Assisted Living Nurse Manager.
I don't have any of my documentation for the original test or the INH (back in 1992). I never bothered getting retested because I was told I would always test positive. There was always a question whether or not the PPD WAS positive--1 nurse said yes, a few others said no. Unfortunately, the one who said yes was the one who had to read the test. I've wondered if I should ge re-tested but I was told that the INH would make me always test positive. Maybe that's not the case after all.

I spoke with a nurse from public health today and she stated that if you have ever been positive you can call the public health dept in the state you tested positive and they would have the confirmation you need in regards to the test and treatment. Also in the state I live in if there is no documentation available to confirm a positive test and treatment then the person is given another Mantoux.

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Specializes in Trauma/Critical Care.
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.

To answer your question...yes, you shoud have repeated the PPD test and if positive, then the need for a chest X-ray would had been justified (Please, keep in mind that many insurance companies may no reimburse a X-ray billing, if no documented (+) PPD result). The percentage of people who experience adverse reaction to the test is very minimal. According to the Center of Disease Control and Prevention (CDC): " In general, there is no risk associated with repeated tuberculin skin test placements. If a person does not return within 48-72 hours for a tuberculin skin test reading, a second test can be placed as soon as possible. There is no contraindication to repeating the TST, unless a previous TST was associated with a severe reaction (CDC, para 8)."

Hope this help :)

Center for Disease control and Prevention, 2011. Retrieved July 27, 2011 from

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

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I spoke with a nurse from public health today and she stated that if you have ever been positive you can call the public health dept in the state you tested positive and they would have the confirmation you need in regards to the test and treatment. Also in the state I live in if there is no documentation available to confirm a positive test and treatment then the person is given another Mantoux.

I'm trying to track down all of my immunization records so this helps. THANKS so much for the information!

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I would discourage any individuals from going through the antitubercular regimen if there's no active disease in the lungs. There are serious side effects associated with Rifampin, Isoniazid and Ethambutol. Mandatory creatinine and liver enzyme tests are performed while going through the regimen. Nobody can force you to go through the TX without documented evidence of active TB or symptoms.

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