What to do with a PPD Conversion
Posted By Chris on April 15, 2010
If you are the Staff Developer and the Infection Preventionist you are most likely responsible for Employee Health as well; that includes annual resident and employee Tuberculosis screenings with PPD. What do you do if an employee converts from a negative to a positive PPD?
To begin with, The Preventionist needs to be skilled at administering and interpreting PPDs. Classes are usually available for nurses at the County Health Department; this is a very worthwhile investment for every long-term care facility because realistically speaking, many facilities see frequent staff turnover and in the case of the staff developer, several nurses could be interpreting the results of PPD’s. What are their credentials? Have they been certified? Being a nurse does not infer the skills necessary to interpret redness, swelling, or indurations. One nurse may read an induration incorrectly this year and that reading will affect the results of the annual PPD next year.
The CDC has designed an excellent wall chart for the correct administration and interpretation of PPD’s. The poster is a large and provides actual pictures of administration and interpretations of real indurations. I have personally ordered these posters along with informational fact sheets and brochures to give to my facilities. These were cost free.
Link for TB Interpretation Fact Sheets
Link is for the PPD Administration and Interpretation wall chart; PPD Wall Chart
To get back to what you would do if an employee converted their annual PPD. If there is a conversion, a chest x-ray is ordered and is susequently read as negative by a Radiologist, what then? Is the employee simply sent back to work? Consider this; why would someone convert from a negative PPD to a positive? Either the reading was not accurately interpreted or the person may have been exposed to some form of Tuberculosis. If a chest x-ray is read as negative, that may rule out an active TB cavitary lesion but it does not rule out latent TB. LTB is not infectious to other people but should be evaluated by the health department or a physician. At that time a decision will be made regarding treatment options for Latent TB.
So my advice in the case of PPD conversions is to make sure the nurse who is administrating and interpreting the PPD is qualified to do so. If there is a conversion from negative to positive, always refer the healthcare worker to the County Health Department and follow their recommendations.
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