The Science Journal of the American Association for Respiratory Care

2000 OPEN FORUM Abstracts

COMPARISON OF PHYSICIAN-DIRECTED VS RESPIRATORY CARE PROTOCOL-BASED TUBERCULIN SKIN TESTING

Steve Nivison BS RRT, Virginia DeFilippo MS RRT, Lynn Tanoue MD, Jeffrey Topal MD, Yale-New Haven Hospital, New Haven, Connecticut

Purpose: To determine if tuberculin skin testing performed by Respiratory Care Practitioners (RCP) is more effective than the current practice of testing performed by physicians.
Background: Tuberculin skin testing is an important tool in identifying patients with latent tuberculosis (TB) infection. Given the known efficacy of chemoprophylaxis, identification of these individuals is important in the prevention of future cases of active TB. The current practice at our institution consists of the physician identifying a patient at risk for TB infection, placing a purified protein derivative (PPD) skin test, reading the PPD, and documenting the results in the medical record. A review by Hospital Epidemiology and Infection Control over 2 months showed that of 191 consecutive patients meeting CDC criteria for PPD testing, only 1 (0.5%) had a PPD placed, read and documented. A separate 6 month review of 114 consecutive patients placed on airborne precautions for the possibility of TB infection showed that only 4 (3.5%) had a PPD placed, read, and appropriately documented.
Method: This study compared two groups of patients over a 6 week period. The first group consisted of patients admitted to adult wards in whom tuberculin skin testing was directed by physician selection. Consistent with current standard hospital practice, the physician determined which patients would be screened, placed the PPD, interpreted the result, and made the appropriate documentation. The second group consisted of patients admitted to two internal medicine wards where tuberculin skin testing was directed by a respiratory care protocol. Physicians were informed which patients in this group met CDC criteria for PPD testing. The physician then placed an order for PPD testing. Respiratory Care Practitioners trained in PPD testing then performed PPD placement, reading, and documentation. Patients who were discharged or expired before skin test reading could be performed were excluded from the study. Chi-square was performed for statistical analysis.

Results:

# TB tests ordered # PPDs placed # PPDs read # of ordered tests actually read
Physician - directed skin testing 24 11 9 37.5
Respiratory Care Protocol-based skin testing 26 26 26 100%
P=0.000001

Conclusion: Tuberculin skin testing directed by a respiratory care protocol had a higher completion rate in comparison to traditional skin testing performed by physicians.

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