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What is considered a positive reportable TB test?

Nurses   (580 Views 13 Comments)
by mzsuccess mzsuccess (Member)

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CDC says:

An induration of 5 or more millimeters is considered positive in

-HIV-infected persons

-A recent contact of a person with TB disease

-Persons with fibrotic changes on chest radiograph consistent with prior TB

-Patients with organ transplants

-Persons who are immunosuppressed for other reasons (e.g., taking the equivalent of >15 mg/day of prednisone for 1 month or longer, taking TNF-aantagonists)

An induration of 10 or more millimeters is considered positive in

-Recent immigrants (< 5 years) from high-prevalence countries

-Injection drug users

-Residents and employees of high-risk congregate settings

-Mycobacteriology laboratory personnel

-Persons with clinical conditions that place them at high risk

-Children < 4 years of age

– Infants, children, and adolescents exposed to adults in high-risk categories

>An induration of 15 or more millimetersis considered positive in any person, including persons with no known risk factors for TB. However, targeted skin testing programs should only be conducted am

 

I currently have a client who has 9mm induration- he's asymptomatic. Do I still report to health department?

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laflaca has 5 years experience as a BSN, RN and works as a Public High School Nurse.

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Call the health department, describe the situation and ask if it's reportable (is the patient in one of the listed high risk groups, for whom that measurement is considered positive?).   ... They'll let you know the criteria and procedure in your jurisdiction. They get questions like this all the time.

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9,018 Visitors; 377 Posts

He's not in the high risk groups at all. The health department is closed. The Website says it has to be reported in 24 hours. 

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laflaca has 5 years experience as a BSN, RN and works as a Public High School Nurse.

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Then it's not a positive result, right? No positive result, no reporting.

(Even if it had been positive, you could report it tomorrow- believe me, public health departments are not going to punish you for reporting an asymptomatic positive PPD a couple hours late. If it was suspected botulism or MERS or Ebola or measles... Or if the guy were hacking up blood and had a history of known contact with multidrug resistant TB...then yes, they need a report this minute on the after hours line. But awesome that you are being so conscientious!!)  🙂

 if you work in a hospital, remember you always have the resource of your infection preventionist (who is often a nurse) - she probably can answer your questions and may actually be the facility's designated reporter to public health. Or your infectious disease docs are handy, too.  🙂

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9,018 Visitors; 377 Posts

Sorry but I;m the only nurse currently at my job Mon-friday due to the lead nurse walking out. So how do 

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9,018 Visitors; 377 Posts

18 minutes ago, laflaca said:

Then it's not a positive result, right? No positive result, no reporting.

(Even if it had been positive, you could report it tomorrow- believe me, public health departments are not going to punish you for reporting an asymptomatic positive PPD a couple hours late. If it was suspected botulism or MERS or Ebola or measles... Or if the guy were hacking up blood and had a history of known contact with multidrug resistant TB...then yes, they need a report this minute on the after hours line. But awesome that you are being so conscientious!!)  🙂

 if you work in a hospital, remember you always have the resource of your infection preventionist (who is often a nurse) - she probably can answer your questions and may actually be the facility's designated reporter to public health. Or your infectious disease docs are handy, too.  🙂

Sorry but I;m the only nurse currently at my job Mon-friday due to the lead nurse walking out. So how do I go about documenting? I won't be in tomorrow until 3:30 pm.

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dream'n has 25 years experience and works as a RN.

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If the regulations are to report > 10mm in this patients particular situation and his result is anything < than 10mm, then no you don't need to report it unless there are other factors at play.

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I would call it inconclusive and send him for a quantiferon gold. 

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ruby_jane has 10 years experience as a BSN, RN.

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8 hours ago, EllaBella1 said:

I would call it inconclusive and send him for a quantiferon gold. 

When I did TB nursing we weren't supposed to "break the tie" as it were by doing the blood test - but it sure is tempting. OP-  revisit the risk history one more time on this patient. No travel to Mexico or other countries where TB is more common? Also is the pt diabetic? Heart disease or heart condition? Anything underlying in the immune system that might mask a real positive?

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6 hours ago, ruby_jane said:

When I did TB nursing we weren't supposed to "break the tie" as it were by doing the blood test - but it sure is tempting. 

Curious what you mean by this? I haven't heard that expression before. I only suggested it because the last two hospitals I've worked for got rid of PPDs altogether because of uncertain interpretation situations like this. It seems like a blood test is more straightforward, no? 

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ruby_jane has 10 years experience as a BSN, RN.

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8 minutes ago, EllaBella1 said:

Curious what you mean by this? I haven't heard that expression before. I only suggested it because the last two hospitals I've worked for got rid of PPDs altogether because of uncertain interpretation situations like this. It seems like a blood test is more straightforward, no? 

The public health doc explained it this way: pick one or the other because which result will you believe? His orders were that we do one test and treat based on that result. That was nine years ago.

I don't disagree that the quantiferon/IGRA is easier for a variety of reasons (and not just because I didn't have to chase down a skin test). At the time it was also expensive to process and run. 

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laflaca has 5 years experience as a BSN, RN and works as a Public High School Nurse.

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On 2/25/2019 at 6:00 PM, mzsuccess said:

Sorry but I;m the only nurse currently at my job Mon-friday due to the lead nurse walking out. So how do I go about documenting? I won't be in tomorrow until 3:30 pm. 

Depends on your facility.... But generally if you have 9 mm, just document the 9 mm which in this case is negative  

If you are wondering whether additional testing or evaluation is needed on the clinical end for some reason you haven't mentioned... that's a call to your doc.  But if the correct standard for this patient's situation is 10 mm or 15 mm and you've got 9 mm - your result is negative, and public health doesn't require any report.

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