title: Evaluation of the two-step tuberculin skin test in health care workers at an inner-city medical center.
abstract: The increased rate of tuberculosis (TB) infection and transmission from patients to health care workers (HCWs) has brought awareness of the need for better surveillance programs. The two-step purified protein derivative (PPD) skin test decreases the misinterpretation of a "boosted reaction" as a recent infection with Mycobacterium tuberculosis in HCWs. We reviewed the medical records of 4082 HCWs at an inner-city medical center who had PPD skin-testing performed as a component of the TB medical surveillance program during the years 1994 and 1995. Of those HCWs tested, 3896 (95.4%) returned for the PPD skin-test evaluation. Of those 3896 HCWs, 3659 (93.9%) had a negative baseline PPD skin test, and 237 (6.1%) had a positive skin test. Of those HCWs with a negative baseline skin test, 252 (6.9%) were eligible for the second PPD skin test. Of the 241 who returned for their second PPD skin-test reading, six (2.5%) had positive results. All six cases were foreign-born physician residents with a previous history of Bacille bilié de Calmette-Guérin (BCG) vaccination. We conclude that the two-step PPD skin test method is not indicted for HCWs at this urban medical facility.
authors.affiliation: Division of Occupational and Environmental Medicine, Wayne State University, Detroit, Mich. 48201, USA.
authors.forename: K M
authors.initials: KM
authors.lastname: Hallak
authors.forename: M
authors.initials: M
authors.lastname: Schenk
authors.forename: A V
authors.initials: AV
authors.lastname: Neale
mesh_terms: D006282:Health Personnel; D006786:Hospitals, Urban; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional; D009784:Occupational Diseases / Q000175:diagnosis*; D012189:Retrospective Studies; D014374:Tuberculin Test / Q000295:instrumentation / Q000379:methods*; D014376:Tuberculosis / Q000175:diagnosis* / Q000635:transmission; D014481:United States / Q000453:epidemiology