TB/PPD testing policies and my frustration

[delilas]

I wrote out some incredibly long story about this drama over my TB test, but I decided to just give you a fast breakdown instead.

• Our hospital policy states employees must be TB tested once per year.
  
• I was tested in August 2012 and in December 2012.
  
• I am moderately allergic to the shots (phenol allergy). The reaction is getting worse with every shot, but it was easier to put up with than paying for a CXR.
  
• Our Occ Health decided everyone needed to be tested by May 1st. I provided the proof I've had not one, but two shots in the past 10 months, and they stated I "needed to be on their testing schedule". I explained the allergy and they wouldn't budge.
  
• I live an hour from my hospital, so I went to an urgent care for my shot last Friday. The doctor refused to let me have it, stating there was no earthly reason a nurse should have 3 tb shots in 10 months without direct exposure to TB, and that I will make my allergy worse by getting another.
  
• On informing occ health of this, she told me to go to another facility and not tell them about the allergy or other tests.
  
• On refusing, I was given a "TB Questionnaire" to fill out and told it would substitute. There is no place on the questionnaire to state you are allergic. You can only sign agreeing to the test, or sign stating you have a positive test.
  
• I filled it out and wrote ALLERGIC on the sign line next to my name and faxed it.
  
• I was just called again and told I will be written up for not complying.
  

Help?

[HouTx, BSN, MSN, EdD]

Sounds odd to me. My organization provides free CXR for anyone who has had a reaction to the skin test... no matter whether the reaction was caused by exposure or allergic reaction. It makes no difference because any sort of reaction indicates that continued exposure to the skin test would not be beneficial and, in the case of allergy, cause harm.

Your organization needs to re-visit this policy because the way it is written, it is mandating a procedure that is medically contraindicated. Maybe they don't realize that the organization will be liable for any harm that may result such as triggering an allergic crisis.

My advice? Take it up the chain of command - to the physician that oversees the employee health program if necessary.

[elkpark]

My advice? Take it up the chain of command - to the physician that oversees the employee health program if necessary.

That was going to be my advice, as well. I have had a + Mantoux test for decades, since before nursing school. When I first "turned," I went to my local public health department and completed the year of INH. A few years later, I took a job at a small, rural hospital and the IC nurse there insisted that I had to have a TB test. I explained it was going to be positive, so there was no point, but she insisted so I went along with it. When I mentioned this in passing later on to my PCP, who was also the IC physician for the hospital, he was pretty upset (at the IC nurse) and told me I should never let anyone do a Mantoux test on me again, it can actually be dangerous. Ever since, I've told employers that I have a hx of a + test and there is no further discussion about doing a new test. Some employers have wanted me to get an X-ray, some just do the weird little questionnaire. I would think an allergic reaction would be just as legitimate a reason to not do skin testing.

However, if your employer wants you to have an X-ray in lieu of a skin test because you are allergic, the employer should be paying for that, not you (they should also be providing the skin tests to employees at no charge).

[delilas]

However, if your employer wants you to have an X-ray in lieu of a skin test because you are allergic, the employer should be paying for that, not you (they should also be providing the skin tests to employees at no charge).

I thought that too, and when I brought up a CXR she just said it wasn't necessary...which I don't understand. It'd be a better way to rule out TB than having me fill out a form saying I have no symptoms.

My advice? Take it up the chain of command - to the physician that oversees the employee health program if necessary.

I hadn't thought about going to the overseeing phys - thanks!

[dandk1997RN, MSN, RN]

I love the chain of command idea.

I personally (a little over-aggressive at times, I should warn) would make it clear to them that they would be liable for the reaction and any resulting medical bills. Someone there clearly isn't thinking straight.