title: A university hospital's 10-year experience with tuberculin testing: value of the 2-step tuberculin skin test.
abstract: 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.
authors.affiliation: Upstate Medical University, Syracuse, NY 13210, USA. choudham@upstate.edu
authors.forename: Madhuchhanda
authors.initials: M
authors.lastname: Choudhary
authors.forename: Luis
authors.initials: L
authors.lastname: Ramirez
authors.forename: Ray
authors.initials: R
authors.lastname: Long
authors.forename: Karl B
authors.initials: KB
authors.lastname: Simmons
authors.forename: Donald C
authors.initials: DC
authors.lastname: Blair
authors.forename: Betty A
authors.initials: BA
authors.lastname: Forbes
authors.forename: Kathryn
authors.initials: K
authors.lastname: Same
authors.forename: Robert
authors.initials: R
authors.lastname: Ploutz-Snyder
authors.forename: Frederick B
authors.initials: FB
authors.lastname: Rose
mesh_terms: 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