An ongoing dialogue on HIV/AIDS, infectious diseases,
May 19th, 2019
CDC Does Us a Huge Favor by Advising Against Annual Screening of Healthcare Workers for Latent TB
There are definitely things we do in medicine just because that’s how we’ve always done them.
Among these evidence-free actions, we can include yearly screening for latent TB infection (LTBI) in all healthcare workers
If we carefully examine the rationale behind this practice — as this thorough review nicely does — one would be hard-pressed to find any other reason for this time- and labor-intensive annual flog.
Why does annual LTBI screening make no sense?
- Evidence from clinical studies that this strategy reduces TB incidence in US healthcare workers? Zero.
- Incidence of TB in the US over the past several decades? Steadily down, now at historic lows.
- Conversion of tuberculin skin tests (TSTs) or interferon gamma release assays (IGRAs) among healthcare workers without an obvious TB exposure? Vanishingly rare.
- The testing is easy-to-do, highly accurate, and inexpensive? No to all.
Indeed, that’s why the new recommendation, from a joint effort by the National Tuberculosis Controllers Association and CDC, is so welcome:
In the absence of known exposure or evidence of ongoing TB transmission, U.S. health care personnel … without LTBI should not undergo routine serial TB screening or testing at any interval after baseline (e.g., annually).
Extra points for clarity!
Encouragingly, all the ID and TB specialists I’ve queried lend their enthusiastic support to this change in policy. And this includes that extremely careful bunch who specialize in infection control.
Now we just need to turn this policy into action — which can start by dismantling serial testing requirements in hospitals and other healthcare facilities nationally.
Think what we can do with all that freed-up time!
Maybe even correct spelling errors on fax cover sheets.
"My name is Sax — that's spelled S-A-X, like the musical instrument."
Have been saying that for decades, so guess something like this fax cover sheet was bound to happen eventually. (With apologies to spell-checkers everywhere.) pic.twitter.com/3KMsJt7kO8— Paul Sax (@PaulSaxMD) May 16, 2019
3 Responses to “CDC Does Us a Huge Favor by Advising Against Annual Screening of Healthcare Workers for Latent TB”
Paul E. Sax, MD
Contributing Editor
NEJM Journal Watch
Infectious Diseases
Biography | Disclosures | Summaries
Learn more about HIV and ID Observations.
NEJM Journal Watch — Recent Infectious Disease Articles- Sulopenem Etzadroxil plus Probenecid (Orlynvah) for Uncomplicated Urinary Tract Infections
- Radiolabeled p-Aminobenzoic Acid as a Marker to Detect Bacterial Endocarditis
- Clostridioides difficile Vaccines: Promising Contenders
- Observations from ID and Beyond: Marking a Social Media Mass Migration — Until the Next One
- Incidence of Autoimmune Diseases Involving the Skin, After Acute COVID-19
I was excited to read this a few days ago. No more routine, annual TB testing after a baseline test. But wait! Healthcare facilities will have to make policy changes. Hmm, I wonder how long that will take. As long as it takes them to realize this will save money?
I suspect the manufacturers of Tuberculin Purified Protein Derivative aren’t too happy with this new recommendation. A reliable source of revenue has the potential to shrink dramatically and quickly.
Thanks for the Tweet link, Dr. Saxaphone. It made me laugh out loud.
I am wondering if this decision impacts what we are wanting for Health Care Industry Representatives.
This is required every year at the Bexar County jail in San Antonio and also at the Laredo public schools in Laredo Texas.