TST leads to chronic confusion and befuddlement

Chit chat between various occupational health professionals in the US went along these lines;

- At our EH department we require documentation of MMR, Hepatitis B vaccinations in exposure category 1 and 2, Tb skin test within 30 days of hire, if they are over 50 years old we require a 2 step ppd

- I'm very curious why you only require two step testing on staff over 50. I've never come across that recommendation

- the majority of 2 step testing we do are for those over 50.

- I would advise everyone to follow the 2005 MMWR Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health Care Settings, 2005. See page 29 regarding TST testing and recommendations for two step TSTs.

- Granted the TST is not a great test, but I believe it is the best we have.

- In essence, we are still doing 2-step testing when we accept one from the past 12-months. That is considered #1 and the one done at time of hire is #2.

- While OSHA does not have a TB standard, they did/still have a compliance letter related to TB screening. It references older standards but definitely calls for 2-step testing on all new hires.

- The OSHA TB standard was dropped on Dec 31, 2003 (see page 75 of 2005 MMWR guidelines for more information)...Lack of two step baseline testing could lead to a citation.

- CDC has also stated that Quantiferon Gold Testing can replace all uses of TB skin testing. This would eliminate the need for two step testing and since ok by CDC, should meet any inspectors needs.