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.

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.

I was told I needed to take INH for 6 months so that's what I did (back in 1992). I was told that I needed it to prevent getting active TB and spreading it since I was a carrier. My chest xrays have always been negative. Is INH different than the drugs you mentioned? I was never tested for anything during the time on INH.

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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.

Yeah, I had the same thing happen, and at my new place of work, they INSISTED on testing me again. Lo and behold, I was NOT positive. I would guess that someone long ago read it incorrectly, and I went through too many unnecessary CXR's, and a slew of antituberculin drugs as a result.

The test and the parameters around have changed, talk to your HCP about it.

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Yeah, I had the same thing happen, and at my new place of work, they INSISTED on testing me again. Lo and behold, I was NOT positive. I would guess that someone long ago read it incorrectly, and I went through too many unnecessary CXR's, and a slew of antituberculin drugs as a result.

The test and the parameters around have changed, talk to your HCP about it.

I have an appt on Monday with my doctor to figure out my immunizations for school (not looking forward to that as I have NO records!). I'm going to ask about having a PPD done. I would love to not have to pay for those darn chest xrays anymore! Thanks for posting, steelydanfan!

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I was told I needed to take INH for 6 months so that's what I did (back in 1992). I was told that I needed it to prevent getting active TB and spreading it since I was a carrier. My chest xrays have always been negative. Is INH different than the drugs you mentioned? I was never tested for anything during the time on INH.

I don't blame you for going through the TX. You were not as knowledged about the subject, and believe or not-most family MDs don't come across TB patients and sometimes they aren't as knowledged as well. My assumption is you were probably treated for latent TB, meaning you had probably been exposed to the bacilli( based on a positive PPD result) but not sick from it. There is no way on this planet you could have spread it to others. TB is only spread by those with active disease, and who's smears and cultures have undergone laboratory testing and came out positive. First world nations take drastic measures to prevent TB from becoming a pendemic again, and treating people before active disease is one of them.

As a patient with a history of a positive PPD but a negative CXR, you have the right to refuse antitubercular TX.

As a patient with active tuberculosis in the lungs, it is mandatory to take TB antibiotics inorder to stop the spread of infection to the public. Such TX programs are run by counties and patient details are reportable to the CDC and the State health department.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I don't blame you for going through the TX. You were not as knowledged about the subject, and believe or not-most family MDs don't come across TB patients and sometimes they aren't as knowledged as well. My assumption is you were probably treated for latent TB, meaning you had probably been exposed to the bacilli( based on a positive PPD result) but not sick from it. There is no way on this planet you could have spread it to others. TB is only spread by those with active disease, and who's smears and cultures have undergone laboratory testing and came out positive. First world nations take drastic measures to prevent TB from becoming a pendemic again, and treating people before active disease is one of them.

As a patient with a history of a positive PPD but a negative CXR, you have the right to refuse antitubercular TX.

As a patient with active tuberculosis in the lungs, it is mandatory to take TB antibiotics inorder to stop the spread of infection to the public. Such TX programs are run by counties and patient details are reportable to the CDC and the State health department.

Years ago....you had a positive TB, you were treated. Period. With the onset of MDRTB and the resurgence of TB, the guidelines have changed to try to curtail the pandemic resurgence of TB amongst ourselves and third world countries. Not all positive TB tests years ago were "latent TB" and there were many "false positives" as the serum in the Mantoux was different with different preservatives that many reacted to and NOT that they were exposed to the bacilli somewhere. :)

http://www.cdc.gov/tb/publications/guidelines/infectioncontrol.htm

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