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Annual Tuberculin Skin Testing of Employees at a University Hospital: A Cost-Benefit Analysis

Published online by Cambridge University Press:  21 June 2016

Issam Raad ,
Janet Cusick ,
Robert J. Sherertz ,
Mouin Sabbagh  and
Nora Howell
Issam Raad*
Affiliation:
University of Florida Department of Medicine, Division of Infectious Diseases, Gainesville, Florida
Janet Cusick
Affiliation:
University of Florida Department of Medicine, Division of Infectious Diseases, Gainesville, Florida
Robert J. Sherertz
Affiliation:
University of Florida Department of Medicine, Division of Infectious Diseases, Gainesville, Florida
Mouin Sabbagh
Affiliation:
University of Florida Department of Medicine, Division of Infectious Diseases, Gainesville, Florida
Nora Howell
Affiliation:
University of Florida Department of Medicine, Division of Infectious Diseases, Gainesville, Florida
*
Infectious Diseases, M.D. Anderson Hospital, University of Texas-Box 47, 1515 Holcombe Boulevard, Houston, TX 77030
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Abstract

The usefulness of routine annual tuberculin skin testing (purified protein derivative [PPD]) of hospital employees has been questioned. Between 1984 and the end of 1987 the PPD conversion rates of hospital employees at a university and psychiatric hospital in North Florida were compared. The number of employees in both hospitals were almost equal and compliance with the annual testing was more than 95%. In the psychiatric hospital tuberculosis screening of patients was practiced on admission and annually thereafter. Although no unsuspected smear-positive tuberculosis patients were diagnosed in the psychiatric hospital as compared to four in the university hospital, the annual conversion rates of employees were 0.42% and 0.13%, respectively (p>0.001). However, the ratios of these conversion rates to the incidence of tuberculosis in the counties where these hospitals are located respectively were similar (20.0 vs 24.3, p=0.7). The community seems be the major source of the PPD conversion. At the university hospital more than $70,000 was spent on the annual PPD testing to discover 15 converters; nine had no or minimal contact with patients and only two complied with isoniazid (INH) prophylaxis. Annual PPD testing is not cost effective in hospitals with a low annual conversion rate among its employees and with low tuberculosis case rates in the hospital and the surrounding community.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 10 , Issue 10 , October 1989 , pp. 465 - 469
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1989

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