TB Chest X-Ray

[nurseguy213, LVN]

I got exposed to TB and have been positive since 2006. My employer at the time told me that I now need to take chest x-rays because the skin test will always be positive. I've had yearly chest x-rays a requirement for work since then. I'ts 2018 and I'm applying at a hospital, they refused my clear chest x-ray taken a day before I applied. They are demanding a skin test or $140 blood test followed by a clear chest x-ray. They asked if I could provide proof of the positive PPD from 2006! Is this fair? Every other medical facility I worked at accepted my clear chest x-ray.

[Rocknurse, MSN, APRN, NP]

You might benefit from a Quantiferon test although it may be positive depending on how long ago your exposure was. Here is some good information about it:

What does a positive QFT result mean in patients treated for active disease a long time

ago?

A positive QFT result is meaningful and, even in patients treated for active disease a long time ago, suggests M. tuberculosis infection is likely to be still present. However, as previously mentioned, QFT does not differentiate active disease from LTBI and may even remain positive for a considerable period of time in individuals who have cleared their infection. Overall, an individual who has been treated for active TB a long time ago and now tests positive by QFT may have been re-infected-or may still carry their old infection-and should be clinically evaluated for active TB

https://www.quantiferon.com/wp-content/uploads/2017/05/PROM-10157_FAQs-Health-Professionals-Rev001v02.pdf

I can't have a PPD test because I had a BCG inoculation so I always get the Quantiferon test done and both my employer and my school accept that.

[Triddin]

The employer gets to set the rules for if they hire you or not. It might not be fair, but unfortunately, that's the way it is

[nursej22, MSN, RN]

You may want to check with your local health department about the most appropriate screening for you, and you may wish to be treated for latent TB infection, if you have not been already.

Our health department does not recommend routine cxrays unless someone is showing symptoms of active TB disease: productive cough, hemoptysis, drenching night sweats, unexplained weight loss, new, unexplained fatigue, lymphadenopathy.

If you have had positive skin tests then your QFT most likely will be positive as well. And people will usually continue to have positive QFTs even after successful treatment of LTBI or active disease. QFT is detecting immune response, which continues even after cure.

[cleback]

Agree with previous poster that they get to make the rules, unfortunately. Usually the nurses are following a protocol that is signed off or approved by a facility physician, so they usually don't have a lot of independent practice. Usually boils down to the set protocol.

But I find it odd that you didnt retain documentation about your positive ppd, latent tbi treatment, etc. I keep records of all my ppds with my vaccination records. It's not an unreasonable request to see your positive from 2006. If you were to pursue ltbi treatment now, the doc would ask for the same-- previous records or repeat ppd/qft and cxr. It's just healthcare... documentation is always required.