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TB Management

Healthcare Workers

Are HCP at increased risk for TB infection?

Healthcare personnel (HCP) include both paid and unpaid individuals in healthcare settings who may come into contact with patients or infectious materials, directly or indirectly. Healthcare personnel come in various roles, like doctors, nurses, students, and even non-clinical staff such as administrators, janitors, and volunteers. They all work in healthcare settings and can be exposed to infectious materials that might be passed between patients and staff (1).

They face a higher risk of contracting tuberculosis (TB) than the general population (2,3). TB can spread between patients and HCP in healthcare settings, and this happens worldwide, regardless of the TB rates in a given country (3).

Keeping HCP (and patients) safe: TB screening and testing guidelines

The Centers for Disease Control and Prevention (CDC) recommends that in any healthcare setting, it's crucial to establish clear policies and procedures for TB control. These guidelines help figure out what steps to take to reduce the chances of TB spreading. They include screening, testing and assessing HCP who might be exposed to TB (4).

On May 17, 2019 (and updated in 2022), the CDC and the National TB Controllers Association (NTCA) issued updated 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, if an HCP has been in close contact with someone who might have infectious TB and didn't have proper protection, they should get a symptom check and additional testing if needed.
  • Healthcare facilities might consider using annual TB screening for certain groups at increased occupational risk for TB exposure, like respiratory therapists, or in certain settings if transmission has occurred in the past, such as 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.
Joining the healthcare field? Watch to find out how QFT-Plus delivers swift, precise TB test results for a speedy onboarding process.

IGRAs drive positive change in the HCP testing landscape

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.

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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 October 24, 2023)

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 (2022). https://www.cdc.gov/tb/topic/testing/healthcareworkers.htm (accessed October 24, 2023)

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.