title: Pre-placement screening for tuberculosis in healthcare workers.
abstract: BACKGROUND
  Healthcare workers (HCWs) are at occupational risk of contracting and transmitting tuberculosis (TB). Despite national guidance, the optimal process for the pre-placement screening of new entrant HCWs for TB in the UK is not certain, nor the appropriateness of using a one-step interferon gamma release assay (IGRA) screening programme.
  
  
  OBJECTIVE
  To assess the potential for an IGRA-only TB screening programme for new entrant HCWs, and identify cost savings achieved through this process.
  
  
  METHODS
  We conducted a retrospective analysis of IGRA and tuberculin skin tests (TST) within our occupational health service over a 3-year period. HCWs with markedly discordant test results (IGRA negative, TST positive) were followed up to determine whether they developed active TB. We also estimated the yearly cost savings if the existing two-step process was replaced with an IGRA-only programme.
  
  
  RESULTS
  Totally, 96/1258 (8%) HCWs had positive IGRA results; 788 TSTs were performed for newly screened IGRA-negative HCWs without Bacille Calmette-Guérin scars, among which 597 (76%) tested negative (TST <6 mm). None of the 10 individuals with grossly discordant test results (TST >15 mm) developed active TB during the study period. We calculated savings of £20,453 if the two-step process was replaced with an IGRA-only programme.
  
  
  CONCLUSIONS
  The absence of disease progression in individuals with markedly discordant results in this study suggest that an IGRA-only screening programme for new HCWs in the UK is feasible, and may be safe although our follow-up period was insufficient. Our results also suggest that substantial cost savings can be made by using this programme.
authors.affiliation: Sheffield Occupational Health Service, Silverwood, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK.
authors.forename: P
authors.initials: P
authors.lastname: Giri
authors.affiliation: Sheffield Occupational Health Service, Silverwood, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK, subhashis.basu@sth.nhs.uk.
authors.forename: S
authors.initials: S
authors.lastname: Basu
authors.affiliation: Sheffield Occupational Health Service, Silverwood, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK.
authors.forename: T
authors.initials: T
authors.lastname: Sargeant
authors.affiliation: Sheffield Occupational Health Service, Silverwood, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK.
authors.forename: A
authors.initials: A
authors.lastname: Rimmer
authors.affiliation: Department of Respiratory Medicine, Northern General Hospital, Sheffield S5 7AU, UK.
authors.forename: O
authors.initials: O
authors.lastname: Pirzada
authors.affiliation: Dalhousie Medicine New Brunswick (DMNB), Saint John, New Brunswick E2L 4L5, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Adisesh
mesh_terms: D003362:Cost-Benefit Analysis; D006282:Health Personnel; D006801:Humans; D059425:Interferon-gamma Release Tests / Q000191:economics / Q000379:methods*; D008403:Mass Screening / Q000191:economics / Q000379:methods*; D012189:Retrospective Studies; D014374:Tuberculin Test / Q000191:economics / Q000379:methods*; D014376:Tuberculosis / Q000175:diagnosis* / Q000191:economics / Q000276:immunology; D006113:United Kingdom
keywords: Epidemiology; interferon gamma; mantoux; occupational health; tuberculosis; vaccination.