staffTRAK-TB: Software for Surveillance of Tuberculosis Infection in Healthcare Workers

1999 ◽  
Vol 20 (11) ◽  
pp. 770-777 ◽  
Author(s):  
Dale R. Burwen ◽  
M. Franklin Seawright
Keyword(s):  
Skin Test ◽  
Healthcare Workers ◽  
Data Transfer ◽  
Skin Testing ◽  
Lessons Learned ◽  
Tuberculosis Infection ◽  
Skin Tests ◽  
Tuberculin Skin Testing ◽  
Work Location ◽  
Conversion Rates

AbstractThe Centers for Disease Control and Prevention (CDC) recommends periodic tuberculin skin testing of healthcare workers with potential exposure to Mycobacterium tuberculosis. However, many healthcare facilities have neither a system to identify workers due for their skin test nor a means of analyzing aggregate data. To illustrate some of the complexities involved in tuberculin skin test (TST) tracking and analysis, and how these might be addressed, this report describes a software package called staffTRAK-TB, developed by the CDC to facilitate surveillance of tuberculosis infection in healthcare workers. staffTRAK-TB records data for each healthcare worker, including demographic information, occupation, work location, multiple TST results, and results of evaluations to determine if clinically active tuberculosis is present. Programmed reports include lists of workers due and overdue for skin tests, and skin test conversion rates by occupation or worksite. Standardization of types of occupations and locations allows data from multiple facilities to be aggregated and compared. Data transfer to the CDC can be performed via floppy diskettes. staffTRAK-TB illustrates important issues in software structure, standardization of occupation and work-location information, relevant data items, and reports and analyses that would be useful in practice. Developing software that adequately addresses the epidemiological issues is complex, and the lessons learned may serve as a model for hospital epidemiologists, infection control personnel, occupational health personnel, and computer programmers considering software development in this area or trying to optimize their facility's TST surveillance.

A prospective randomized trial of maintenance versus nonmaintenance intravesical bacillus Calmette-Guérin therapy of superficial bladder cancer.

1987 ◽  
Vol 5 (3) ◽  
pp. 441-449 ◽  
Author(s):  
R A Badalament ◽  
H W Herr ◽  
G Y Wong ◽  
C Gnecco ◽  
C M Pinsky ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Skin Test ◽  
Tumor Recurrence ◽  
Skin Testing ◽  
Prospective Randomized Trial ◽  
Skin Tests ◽  
Tuberculin Skin Testing ◽  
Bacillus Calmette Guerin ◽  
Bcg Therapy

Between August 1981 and July 1984, 93 patients with polychronotopic superficial papillary carcinoma (Ta and/or T1), flat carcinoma in situ (Tis), or concomitant superficial papillary and in situ bladder carcinoma were entered into a prospective randomized trial of maintenance v nonmaintenance intravesical bacillus Calmette-Guérin (BCG) therapy. Forty-six patients who received BCG weekly for 6 weeks were compared with 47 patients receiving the six-weekly doses of BCG plus monthly BCG for 2 years. Both groups were evaluated every 3 months by cytology, cystoscopy, and biopsy. A significant reduction in the number of recurrent tumors per patient-month was demonstrated for both groups (P less than .0001); however, the difference in reduction of tumors between the two groups was not significant. Additionally, patients receiving maintenance and nonmaintenance therapy had similar tumor recurrence and progression rates. These results indicate that monthly maintenance BCG does not prevent, delay, or reduce tumor recurrence or progression observed with the 6-week regimen. Maintenance BCG was associated with increased local toxicity, primarily dysuria, frequency, and urgency. Dosage reduction was required in 22 of 47 patients (46.8%). When the data were subjected to multivariate analysis, the presence or absence of tumor following induction BCG and PPD skin test results were found to be significant variables. Controlling for either the presence or absence of tumor following induction BCG, tumor recurrence and progression rates were not significantly different for the two treatment groups. However, the absence of tumor after induction BCG was associated with a longer disease-free duration (P = .00001) and time to progression (P = .095). Patients with a reactive tuberculin skin test before and after induction BCG had significantly less tumor recurrences than patients with different PPD skin tests results (P = .02). Tumor progression was not related to tuberculin skin testing.

Utility of Dual Skin Tests to Evaluate Tuberculin Skin Test Reactions of 10 to 14 mm in Healthcare Workers

2003 ◽  
Vol 24 (11) ◽  
pp. 821-824 ◽  
Author(s):  
Bryan J. Marsh ◽  
Joshua San Vicente ◽  
C. Fordham von Reyn
Keyword(s):  
Occupational Health ◽  
Skin Test ◽  
Healthcare Workers ◽  
Medical Center ◽  
Skin Testing ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Health Department ◽  
The United States ◽  
Skin Tests

AbstractObjective:To define the utility of 10- to 14-mm reactions to a Mycobacterium tuberculosis purified protein derivative (PPD) skin test for healthcare workers (HCWs).Design:Blinded dual skin testing, using PPD and M. avium sensitin, of HCWs at a single medical center who had a 10-to 14-mm reaction to PPD when tested by personnel from the Occupational Health Department as part of routine annual screening.Setting:A single tertiary-care academic medical center.Participants:Employees of the medical center who underwent routine annual PPD screening and were identified by the Occupational Health Department as having a reaction of 10 to 14 mm to PPD.Results:Nineteen employees were identified as candidates and 11 underwent dual skin testing. Only 4 (36%) had repeat results for PPD in the 10- to 14-mm range, whether read by Occupational Health Department personnel or study investigators. For only 5 (45%) of the subjects did the Occupational Health Department personnel and study investigators concur (± 3 mm) on the size of the PPD reaction. Two of the 4 subjects with reactions of 10 to 14 mm as measured by the study investigators were M. avium sensitin dominant, 1 was PPD dominant, and 1 was nondominant.Conclusion:A reaction of 10 to 14 mm to PPD should not be used as an indication for the treatment of latent tuberculosis (TB) infection in healthy HCWs born in the United States with no known exposure to TB.

scholarly journals Simulation of risk of tuberculosis infection in healthcare workers in hospitals of an intermediate incidence country

2014 ◽  
Vol 143 (12) ◽  
pp. 2639-2647 ◽  
Author(s):  
J. OCHOA ◽  
D. HINCAPIÉ-PALACIO ◽  
H. SEPÚLVEDA ◽  
D. RUIZ ◽  
A. MOLINA ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Skin Testing ◽  
Risk Groups ◽  
Tuberculosis Infection ◽  
Risk Level ◽  
Infection Prevalence ◽  
Tuberculin Skin Testing ◽  
Interferon Gamma Release Assays ◽  
Hospital Infection Control ◽  
Assessment Approach

SUMMARYWe simulated the frequency of tuberculosis infection in healthcare workers in order to classify the risk of TB transmission for nine hospitals in Medellín, Colombia. We used a risk assessment approach to estimate the average number of infections in three risk groups of a cohort of 1082 workers exposed to potentially infectious patients over 10- and 20-day periods. The risk level of the hospitals was classified according to TB prevalence: two of the hospitals were ranked as being of very high priority, six as high priority and one as low priority. Consistent results were obtained when the simulation was validated in two hospitals by studying 408 healthcare workers using interferon gamma release assays and tuberculin skin testing. The latent infection prevalence using laboratory tests was 41% [95% confidence interval (CI) 34·3–47·7] and 44% (95% CI 36·4–51·0) in those hospitals, and in the simulation, it was 40·7% (95% CI 32·3–49·0) and 36% (95% CI 27·9–44·0), respectively. Simulation of risk may be useful as a tool to classify local and regional hospitals according to their risk of nosocomial TB transmission, and to facilitate the design of hospital infection control plans.

The Importance of Two-Step Tuberculin Skin Testing for Newly Employed Healthcare Workers

2006 ◽  
Vol 27 (5) ◽  
pp. 512-514 ◽  
Author(s):  
Elizabeth C. Frenzel ◽  
Georgia A. Thomas ◽  
Hend A. Hanna
Keyword(s):  
Tuberculin Skin Test ◽  
Skin Test ◽  
Healthcare Workers ◽  
Skin Testing ◽  
Older Age ◽  
Second Step ◽  
Tuberculin Skin Testing ◽  
Test Results ◽  
History Of ◽  
Male Sex

At the time of hire, 4059 of 6522 healthcare workers required a 2-step tuberculin skin test; 114 workers (2.8%) demonstrated a boosted reaction after the second step. Boosted reactions were significantly associated with male sex and older age. A verbal history of previous tuberculin skin test results was not a reliable indicator of baseline tuberculin skin test status at the time of hire.

Update on Tuberculosis Skin Testing of Children

PEDIATRICS ◽  
1996 ◽  
Vol 97 (2) ◽  
pp. 282-284 ◽  
Author(s):  
Keyword(s):  
Health Care ◽  
Children And Adolescents ◽  
Skin Test ◽  
Skin Testing ◽  
The United States ◽  
Skin Tests ◽  
Tuberculin Skin Testing ◽  
Increased Risk ◽  
Local Risk ◽  
Positive Results

In January 1994, the Committee on Infectious Diseases published detailed guidelines on tuberculin skin testing of infants, children, and adolescents for the detection of tuberculous infections. This supplement to the 1994 statement is written to update and clarify several issues regarding the frequency of skin testing for children at increased risk of acquiring tuberculosis. In this document, children will refer to infants, children, and adolescents. The recommendations regarding the preferred use of the Mantoux skin test and the interpretation of skin test results remain unchanged and will not be repeated here. The interpretation guidelines for indurations of 5, 10, and 15 mm in diameter basically remain unchanged (Table 1). The overall emphasis to control tuberculosis in the United States should be placed on access to health care, a thorough history taking of exposure to infectious persons, timely and effective contact investigations, proper interpretation of Mantoux skin tests, and appropriate use of therapy, including directly observed therapy. Variations in the epidemiology of tuberculosis in different locations reinforce the importance of communication with local public health officials and/or experts on tuberculosis. Existing publications can assist in assessing the local risk of acquiring tuberculosis. The recommendations should be considered regardless of previous BCG vaccine administration. The American Academy of Pediatrics continues to encourage focusing tuberculin skin testing on children who are at increased risk of acquiring tuberculosis. Routine tuberculin testing, including school-based programs that include populations at low risk, has either a low yield of positive results or a large number of false-positive results and represents an inefficient use of limited health care resources.

scholarly journals A prevalence study of bovine tuberculosis by using abattoir meat inspection and tuberculin skin testing data, histopathological and IS6110PCR examination of tissues with tuberculous lesions in cattle inEthiopia

2012 ◽  
Vol 51 (No. 11) ◽  
pp. 512-522 ◽  
Author(s):  
Shitaye JE ◽  
B. Getahun ◽  
T. Alemayehu ◽  
M. Skoric ◽  
F. Treml ◽  
...  
Keyword(s):  
Addis Ababa ◽  
Skin Testing ◽  
Dairy Farm ◽  
Granulomatous Inflammation ◽  
Work Load ◽  
Meat Inspection ◽  
Skin Tests ◽  
Tuberculin Skin Testing ◽  
Mesenteric Lymph Nodes ◽  
Tissue Samples

Post mortem surveillances, for the detection of tuberculous lesions in particular depend on the work load time and the diligence of the inspector conducting the examination. The first aim of the study was to determine the trend of occurrence of tuberculous lesions in two abattoirs in Addis Ababa and Debre-Zeit (Ethiopia). The second aim of the study was to determine prevalence of the tuberculin skin test results in 10 dairy farm areas in Addis Ababa. The third aim was to detect tuberculous lesions and causal agents from tissue samples of the respiratory tract and mesenteric lymph nodes of the slaughtered cattle. The ten year (1996–2005) retrospective analysis of the meat inspection of 2 455 289 slaughtered animals showed that 707 (0.028%) were found with tuberculous lesions in parenchymatous organs of which were 699 (0.052%) of 1 336 266 cattle, 4 (0.001%) of 534 436 sheep, 3 (0.001%) of 573 767 goats and 1 (0.009%) of 10 820 pigs. The tuberculous lesions found in cattle were statistically highly significant (P < 0.01) than in other animals. The bovine tuberculin skin tests were conducted in Addis Ababa in 10 farm areas in 85 dairy farms having 2 098 cattle. Positive reactions were obtained from 9 farm areas in 41 (48%) herds which included 392 (19%) of the animals. In a current study, tuberculous lesions were found in 34 (3.5%) animals by the meat inspection surveillance of 984 cattle. Histopathologically, granulomatous inflammation was evident in 3 (8.8%) animals with tuberculous lesions. A highly sensitive PCR (IS6110) was positive in 4 of 34 (11.8%) animals with tuberculous lesions and in 1 (2.9%) of animal without lesions. The analyzed data and these study findings indicated that tuberculosis in cattle is an existing problem inEthiopia which needs to be solved.

Controversial Techniques in Allergy

PEDIATRICS ◽  
1988 ◽  
Vol 82 (6) ◽  
pp. 935-937
Author(s):  
GAIL G. SHAPIRO ◽  
JOHN A. ANDERSON
Keyword(s):  
Respiratory Tract ◽  
Physical Examination ◽  
Skin Test ◽  
Skin Testing ◽  
Skin Tests ◽  
Sensitive Test ◽  
Financial Gain ◽  
Specific Antigens ◽  
Laboratory Procedures ◽  
Allergy Skin Testing

Ten years ago a commentary appeared in Pediatrics entitled "Allergy Skin Testing: Science or Quackery?"1 This statement was a rejoinder to a commentary in Pediatrics in 19752 that included allergy skin testing in a list of laboratory procedures that are abused for financial gain. The gist of the reply was that allergy skin tests themselves were not the problem because they were valid bioassays for IgE antibody to specific antigens. Abuse and quackery set in when numerous, indiscriminately chosen skin tests were performed instead of an appropriate history, physical examination, and carefully selected tests based on that evaluation. The allergy skin test was at that time and remains today the most sensitive test for specific allergic antibody in the skin, its presence there reflecting its presence in the blood and respiratory tract.

scholarly journals Development of a Human Gamma Interferon Enzyme Immunoassay and Comparison with Tuberculin Skin Testing for Detection ofMycobacterium tuberculosis Infection

1998 ◽  
Vol 5 (4) ◽  
pp. 531-536 ◽  
Author(s):  
Nuket Desem ◽  
Stephen L. Jones
Keyword(s):  
Enzyme Immunoassay ◽  
Skin Test ◽  
Skin Testing ◽  
Gamma Interferon ◽  
Tuberculin Skin Testing ◽  
In Vitro Test ◽  
Detection Range ◽  
Ifn Γ

ABSTRACT A sensitive two-step simultaneous enzyme immunoassay (EIA) for human gamma interferon (IFN-γ) has been developed and used as an in vitro test for human tuberculosis (TB) in comparison with tuberculin skin testing. The EIA was shown to be highly sensitive, detecting less than 0.5 IU of recombinant human IFN-γ per ml within a linear detection range of 0.5 to 150 IU/ml. The assay was highly reproducible and specific for native IFN-γ. In addition, the assay detected chimpanzee, orangutan, gibbon, and squirrel monkey IFN-γs. Cross-reactions with other human cytokines or with IFN-γs derived from mice, cattle, or Old World monkeys were not evident. The assay was used to detect TB infection by incubating whole blood overnight with human, avian, and bovine tuberculin purified protein derivatives (PPDs), as well as positive (mitogen)- and negative-control preparations. The levels of IFN-γ in plasma supernatants were then determined. Blood from 10 tuberculin skin test-positive individuals responded predominantly to the human tuberculin PPD antigen and to a lesser extent to bovine and avian PPD antigens. By contrast, blood from 10 skin test-negative individuals showed minimal responses or no response to any of the tuberculin PPDs. Detectable levels of IFN-γ were present in all blood samples stimulated with mitogen. In vivo tuberculin reactivity was correlated with IFN-γ responsiveness in vitro. These results support the further study of the blood culture–IFN-γ EIA system as an alternative to skin testing for the detection of human TB infection.

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