IUPUI, University/ Riley Hospital clinical pre-placement candidates, healthcare & International students
IUPUI Campus Health screens IUPUI pre-placement candidates hired into clinical positions, healthcare and International students for Tuberculosis. Tuberculin Skin Tests (TST-also known as a PPD) are placed to screen for infection and disease in individuals without a documented history of a positive TST.
Quantiferon Gold and the T-spot (a category called IGRA tests) are blood tests that detect tuberculosis in the body. The blood tests are more accurate than the TB skin tests (TST). Pre-placement candidates, with a history of a positive skin test, and international students,with a hsitory of BCG, may have a T-spot done instead of a TST. IGRA testing eliminates the need for a second visit to the clinic to read a TST, and often negates the need for a chest x-ray. If the IGRA test is positive, a chest x-ray is required.
If the TST is positive, the candidate will have blood drawn for an IGRA/T-spot test to determine if tuberculois infection has occurred. If someone wants an IGRA, but has no NEED for it, the individual will be billed for the test. The cost is $105.
If the IGRA is positive a person is diagnosed with Latent Tuberculosis. Individuals with Latent Tuberculosis are not contagious. Latent Tuberculosis may progress into active disease. Individuals with latent Tuberculosis are counseled about treatment to decrease the risk of developing active disease.
Screening of current employees/students with Tuberculin skin tests (TST)
Current employees and students with patient contact are required to be screened annually for TB. TST (also called a PPD) is used to screen for infection and disease.
TST are not placed on Thursdays at IUPUI Campus Health because the clinic is not open to read the test 48-72 hours later. If an individual does not have the test read within the time limit, an IUPUI employee or student is charged $18 to repeat the test.
The form may be taken with the employee to allow a TB certified person, LPN, RN or MD to read the test. The completed form MUST be returned to the clinic or the test will have to be repeated.
5mm or more of induration for HIV + individuals,
10mm or more of induration for healthcare workers
15mm or more of induration for someone with no risk factors.
Fit testing with N-95 HEPA filter masks is done to protect the employee or student from inhaling harmful particles, especially Tuberculosis organisms.
The mask will be provided by your employer after passing a fit-test. Medical conditions and physical characteristics are taken into consideration before a fit test is done.
If an individual is not able to be fitted with a N-95 mask, a PAPR should be use if respiratory protection is needed.
A PAPR is a Personal Air Purifying Respirator. It consists of a hood that covers the head, which connects to an air hose, filter and battery pack.
Hoods are to be used by only one person (personal), but several people may share the other equipment.
Caring for patients with TB
Correct use of a PAPR or N-95 mask greatly decreases the risk of caring for a patient with active or suspected TB.
Patients with active disease or who are suspected of having TB should be placed in isolation as soon as TB is suspected.
Isolation rooms for TB patients have special air systems which prevent the organism from being circulated to other areas.
Patients may have spent time in the hospital before TB is diagnosed or suspected. HCW who have cared for the patient diagnosed with TB are identified by administration and names are sent to Infection Control.
Employees who have been exposed to TB are screened at IUPUI Campus Health with TST as soon as possible and again in 3 months.
Screening and assessing for TB is an ongoing process.
Cases among healthcare workers occur infrequently but regularly.
TB is an infectious disease and we must be vigilant in screening for it. Annual completion of questionnaires and TST placements are important infection control measures.
What is Tuberculosis?
Tuberculosis (TB) is an infectious disease that has infected humans for centuries. It is caused by the organism Mycobacterium tuberculosis. It usually infects the respiratory system but may infect the bones, kidneys, and brain. TB that occurs in the lungs (pulmonary TB) or the larynx (voice box) is most concerning from an infectious disease perspective.
Most cases of TB in the United States are brought by immigrants from Mexico, Latin America, Asia, Africa, Russia, and Eastern Europe. U. S. cities or areas with large populations of homelessness, migrant workers, prisons, and immigrants have the most cases. Children, the elderly, and others with decreased immune system function are most susceptible.
How is it spread?
Droplets containing the organism enter the air when a person with pulmonary or laryngeal TB sneezes, coughs, laughs or sings. The organism is inhaled and reaches the small airways of the lungs to cause pulmonary disease. It takes several hours of close contact with a person with TB to spread the disease or infection to others. This is why TB is usually acquired by members of the same household, close friends or coworkers. A healthcare worker (HCW) who spends a lot of time with a patient with TB is at risk also.