HIV and ID Observations

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