Skin testing for tuberculosis in university teaching hospitals--is there a problem?

Area of Science:

• Infectious Disease
• Hospital Quality Improvement

Background:

• Tuberculin skin testing is crucial for diagnosing latent tuberculosis infection.
• Accurate performance of tuberculin skin testing by healthcare professionals is essential for effective patient management.
• Previous studies indicate variability in skin testing practices within academic medical centers.

Purpose of the Study:

• To evaluate the accuracy of tuberculin skin testing performed by hospital staff.
• To identify factors influencing the correct performance and reading of tuberculin skin tests.
• To assess the impact of changing personnel responsible for skin testing on performance rates.

Main Methods:

• Conducted four annual audits of tuberculin skin tests in a university teaching hospital.
• Assessed adherence to established protocols for test administration and interpretation.
• Compared performance metrics between house staff and trained infection control practitioners.

Main Results:

• House staff demonstrated poor performance in both test administration and reading across the first three years.
• Interventions including direct teaching and written guidelines did not significantly improve house staff performance.
• Transferring responsibility for testing to infection control practitioners in year four resulted in performance rates approaching 100%.

Conclusions:

• House staff at university teaching hospitals often perform tuberculin skin testing inadequately.
• Dedicated, trained personnel, such as infection control practitioners, are more effective in ensuring accurate tuberculin skin testing.
• University teaching hospitals should implement regular assessments and ensure appropriate personnel are assigned for skin testing procedures.