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TB Management

Healthcare Personnel

Healthcare personnel (HCP) refer to all paid and unpaid persons working in healthcare settings who have the potential for direct or indirect exposure to patients or infectious materials (1).

They are at increased risk of tuberculosis (TB) infection compared to the general population (2, 3). Transmission of TB bacteria in healthcare settings can occur from HCP to patients, patients to HCP and between HCP. Virtually every country in the world, regardless of their TB incidence, has reported the spread of TB in healthcare settings to both patients and HCP (3).

How can we protect HCP (and patients) in healthcare settings from TB?

The Centers for Disease Control and Prevention (CDC) recommends that in all healthcare settings, policies and procedures for TB control should be put into place to determine the actions necessary to minimize the risk for transmission of TB. This includes screening, testing and evaluating HCP who are at risk for exposure to TB disease (4).

On May 17, 2019 (and updated in 2021), the CDC and the National TB Controllers Association (NTCA) issued new TB screening and testing guidelines for HCP (4):

  • All U.S. HCP should have baseline TB screening upon hire, that is, pre-placement, including a risk assessment, TB symptom evaluation and TB testing.
  • Annual TB testing is not recommended unless there is a known exposure or ongoing transmission. However, HCP should have a timely symptom evaluation and additional testing, if indicated, after known exposure to a person with potentially infectious TB disease without use of adequate personal protection.
  • Healthcare facilities might consider using annual TB screening for certain groups at increased occupational risk for TB exposure (e.g., respiratory therapists) or in certain settings if transmission has occurred in the past (e.g., emergency departments).
  • HCP should receive annual TB education about TB risk factors, the signs and symptoms of TB disease and TB infection control policies and procedures.
TB screening, Healthcare workers examining x-ray picture

Either a TB blood test (IGRA) or a TB skin test (TST) can be used to test for TB infection, though the CDC, ATS and IDSA preferentially recommend IGRA over TST for the majority of the U.S. testing population (5).

In the HCP testing landscape, if the TB skin test is used to test for TB infection upon hire, two-step testing should be conducted. This is because some people with latent TB infection have a negative reaction when tested years after being infected. Two-step testing is, however, not required for IGRAs (4), thus ensuring faster HCP onboarding compared with the two-step TST.

QuantiFERON-TB Gold Plus (QFT-Plus) is an IGRA that helps ensure rapid and reliable onboarding, while also serving a critical role in risk-based TB testing and active TB contact investigations – the backbone of the U.S. TB prevention policies.

Dr. Steve Young leads a reference lab in New Mexico, supporting a network of hospitals that rely on his team for the state’s infection control program. See how they evaluated the TST and IGRAs, and then chose QFT-Plus as their trusted solution for TB screening and prevention.

Streamline onboarding with QuantiFERON-TB Gold Plus
QuantiFERON-TB Gold Plus provides accurate, single visit TB testing.
References:
  1. Centers for Disease Control and Prevention. Infection Control in Healthcare Personnel: Infrastructure and Routine Practices for Occupational Infection Prevention and Control Services (2019). https://www.cdc.gov/infectioncontrol/guidelines/healthcare-personnel/appendix/terminology.html (accessed May 19, 2022)
  2. Diel, R., Seidler, A., Nienhaus, A., Rusch-Gerdes, S., Niemann, S. (2005) Occupational risk of tuberculosis transmission in a low incidence area. Respir. Res. 6.
  3. Baussanon, I., Nunn, P., Williams, B., Pivetta, E., Bugiani, M., Scano, F. (2011) Tuberculosis among health care workers. Emerg. Infect. Dis. 17(3), 488-494.
  4. Centers for Disease Control and Prevention. TB Screening and Testing of Health Care Personnel (2021). https://www.cdc.gov/tb/topic/testing/healthcareworkers.htm (accessed May 19, 2022)
  5. Lewinsohn, D.M. et al. (2017) Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines: Diagnosis of Tuberculosis in Adults and Children. Clin Infect Dis. 64, 111-115.

QFT-Plus is an in vitro diagnostic aid for detection of Mycobacterium tuberculosis infection. QFT-Plus is an indirect test for M. tuberculosis infection (including disease) and is intended for use in conjunction with risk assessment, radiography, and other medical and diagnostic evaluations. QFT-Plus Package Inserts, available in multiple languages, as well as up-to-date licensing information and product-specific disclaimers can be found at www.QuantiFERON.com.