A university hospital's 10-year experience with tuberculin testing: value of the 2-step tuberculin skin test.
BACKGROUND
The usefulness of the 2-step tuberculin skin test as a tool for monitoring tuberculosis exposure among health care workers is controversial.


OBJECTIVE
We aimed to determine the cost-effectiveness and influence of initiation of a preemployment, 2-step tuberculin skin-testing program on the annual tuberculin skin conversion rate among a university hospital's health care workers.


METHODS
The tuberculin skin test conversion rates among the recipients of 31,729 tuberculin skin tests over 10 years were retrospectively analyzed. Data from the first 6 years of this study were generated when a single preemployment tuberculin skin test was utilized. Data from the last 4 years were gathered after the advent of a preemployment 2-step program. A cost analysis of the 2-step tuberculin skin test process was performed to determine the annual cost of this program.


RESULTS
Relative risk of a conversion was 8.43 times less during the 2-step period when compared with the years when a single tuberculin skin test was given at the start of employment (P < .001). A cost analysis showed that the annual added cost of the 2-step program was approximately 9,565 US dollars.


CONCLUSIONS
A greater than 8-fold reduction in the number of annual tuberculin skin test conversion coincided with, but could not be attributed solely to, the initiation of a 2-step program in our hospital. The Infection Control Committee concluded that the 2-step testing program is essential to achieve the hospital's goal of a 0% annual tuberculin skin test conversion rate and that the annual cost is justified.
Choudhary
Madhuchhanda
M
Upstate Medical University, Syracuse, NY 13210, USA. choudham@upstate.edu
Ramirez
Luis
L
Long
Ray
R
Simmons
Karl B
KB
Blair
Donald C
DC
Forbes
Betty A
BA
Same
Kathryn
K
Ploutz-Snyder
Robert
R
Rose
Frederick B
FB
D016009:Chi-Square Distribution; D003362:Cost-Benefit Analysis; D006785:Hospitals, University; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000517:prevention & control; D008403:Mass Screening / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D009518:New York; D010564:Personnel, Hospital / Q000706:statistics & numerical data*; D014374:Tuberculin Test / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D014376:Tuberculosis / Q000276:immunology; D014481:United States; D014489:United States Occupational Safety and Health Administration / Q000592:standards