{"id":9224,"date":"2019-05-19T01:11:46","date_gmt":"2019-05-19T05:11:46","guid":{"rendered":"https:\/\/blogs.nejm.org\/hiv-id-observations\/?p=9224"},"modified":"2019-05-19T01:12:26","modified_gmt":"2019-05-19T05:12:26","slug":"cdc-does-us-a-huge-favor-by-advising-against-annual-screening-of-healthcare-workers-for-latent-tb","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/cdc-does-us-a-huge-favor-by-advising-against-annual-screening-of-healthcare-workers-for-latent-tb\/2019\/05\/19\/","title":{"rendered":"CDC Does Us a Huge Favor by Advising Against Annual Screening of Healthcare Workers for Latent TB"},"content":{"rendered":"<p><a href=\"https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2019\/05\/ThinkTBPoster.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright wp-image-9226\" src=\"https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2019\/05\/ThinkTBPoster.jpg\" alt=\"\" width=\"305\" height=\"234\" srcset=\"https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2019\/05\/ThinkTBPoster.jpg 500w, https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2019\/05\/ThinkTBPoster-300x230.jpg 300w\" sizes=\"auto, (max-width: 305px) 100vw, 305px\" \/><\/a>There are definitely things we do in medicine just because <em>that&#8217;s how we&#8217;ve always done them.<\/em><\/p>\n<p>Among these evidence-free actions, we can include yearly screening for latent TB infection (LTBI) in all healthcare workers<\/p>\n<p>If we carefully examine the rationale behind this practice &#8212; as <a href=\"https:\/\/www.amjmed.com\/article\/S0002-9343(19)30276-1\/fulltext\" target=\"_blank\" rel=\"noopener noreferrer\">this thorough review<\/a>\u00a0nicely does &#8212; one would be hard-pressed to find any other reason for this time- and labor-intensive annual flog.<\/p>\n<p>Why does annual LTBI screening make no sense?<\/p>\n<ul>\n<li><strong>Evidence from clinical studies that this strategy reduces TB incidence in US healthcare workers?<\/strong> Zero.<\/li>\n<li><strong>Incidence of TB in the US over the past several decades?<\/strong> Steadily down, <a href=\"https:\/\/www.cdc.gov\/mmwr\/volumes\/68\/wr\/mm6811a2.htm?s_cid=mm6811a2_w\" target=\"_blank\" rel=\"noopener noreferrer\">now at historic lows.<\/a><\/li>\n<li><strong>Conversion of tuberculin skin tests (TSTs) or interferon gamma release assays (IGRAs) among healthcare workers without an obvious TB exposure?<\/strong> Vanishingly rare.<\/li>\n<li><strong>The testing is easy-to-do, highly accurate, and inexpensive?<\/strong> No to all.<\/li>\n<\/ul>\n<p>Indeed, that&#8217;s why <a href=\"https:\/\/www.cdc.gov\/mmwr\/volumes\/68\/wr\/mm6819a3.htm?s_cid=mm6819a3_w\" target=\"_blank\" rel=\"noopener noreferrer\">the new recommendation<\/a>, from a joint effort by the National Tuberculosis Controllers Association and CDC, is so welcome:<\/p>\n<blockquote><p>In the absence of known exposure or evidence of ongoing TB transmission, U.S. health care personnel &#8230; without LTBI should not undergo routine serial TB screening or testing at any interval after baseline (e.g., annually).<\/p><\/blockquote>\n<p>Extra points for clarity!<\/p>\n<p>Encouragingly, all the ID and TB specialists I&#8217;ve queried lend their enthusiastic support to this change in policy. And this includes that <em>extremely<\/em> careful bunch who specialize in infection control.<\/p>\n<p>Now we just need to turn this policy into action &#8212; which can start by dismantling serial testing requirements in hospitals and other healthcare facilities nationally.<\/p>\n<p>Think what we can do with all that freed-up time!<\/p>\n<p>Maybe even correct spelling errors on fax cover sheets.<\/p>\n<blockquote class=\"twitter-tweet\" data-width=\"500\" data-dnt=\"true\">\n<p lang=\"en\" dir=\"ltr\">&quot;My name is Sax &#8212; that&#39;s spelled S-A-X, like the musical instrument.&quot; <br \/>Have been saying that for decades, so guess something like this fax cover sheet was bound to happen eventually. (With apologies to spell-checkers everywhere.) <a href=\"https:\/\/t.co\/3KMsJt7kO8\">pic.twitter.com\/3KMsJt7kO8<\/a><\/p>\n<p>&mdash; Paul Sax (@PaulSaxMD) <a href=\"https:\/\/twitter.com\/PaulSaxMD\/status\/1129044562419355648?ref_src=twsrc%5Etfw\">May 16, 2019<\/a><\/p><\/blockquote>\n<p><script async src=\"https:\/\/platform.twitter.com\/widgets.js\" charset=\"utf-8\"><\/script><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>There are definitely things we do in medicine just because that&#8217;s how we&#8217;ve always done them. Among these evidence-free actions, we can include yearly screening for latent TB infection (LTBI) in all healthcare workers If we carefully examine the rationale behind this practice &#8212; as this thorough review\u00a0nicely does &#8212; one would be hard-pressed to [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3],"tags":[2896,2897,2898,951],"class_list":["post-9224","post","type-post","status-publish","format-standard","hentry","category-health-care","tag-igra","tag-ppd","tag-tst","tag-tuberculosis"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/9224","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=9224"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/9224\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=9224"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=9224"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=9224"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}