Skip to main content Accessibility help

Tuberculosis Screening in the Long-term Care Setting

  • Loraine E. Price (a1) and William A. Rutala (a1)


Tuberculosis (TB) skin-testing practices in long-term care facilities (LTCFs) in North Carolina (NC) were assessed from a 56% (148/263) response to a comprehensive TB screening questionnaire. TB skin tests were administered to employees on initial employment by 98% and annually by 97% of the LTCFs, generally (74%) by the Mantoux method. Employee skin tests were read at the appropriate time interval of 48 to 72 hours by 91%, but less than half used diameter of induration when interpreting reactive tests. The booster test was performed on new employees at eight (6%) of the LTCFs. TB skin tests were routinely performed on newly admitted residents by 56% or conditionally required by 18%, generally (73%) by the Mantoux method. Resident skin tests were read at the appropriate time interval of 48 to 72 hours by 92%, but again only half correctly interpreted reactive tests as significant. Residents received routine annual skin tests at 71% of the LTCFs, generally (80%) by the Mantoux method. Eight (6%) facilities routinely performed the booster test on newly admitted residents. TB infection prevalence in new employees during 1983 was 8.1% (47/578) in seven LTCFs and in newly admitted residents was 6.4% (7/110) in three LTCFs supplying this data. The five-year mean TB skin test conversion rate among employees was 1.1% (101/9545) in 12 LTCFs and among residents was 0.9% (46/5216) in nine LTCFs supplying this data. Lack of compliance to established TB skin-testing guidelines in NC LTCF was prevalent. In recognition of described endemic and epidemic spread of TB in LTCFs, residents and employees of LTCFs should be screened for TB utilizing established skin-testing practices.


Corresponding author

Division of Infectious Diseases, UNC School of Medicine, 547 Clinical Sciences Bldg. 229H, Chapel Hill, NC 27514


Hide All
1.Alpen, ME, Levison, ME, An epidemic of tuberculosis in a medical school. N Engl J Med 1965:272:718721.
2.Barrett-Connor, E, The epidemiology of tuberculosis in physicians. JAMA 1979;241:3338.
3.Levine, I, Tuberculosis risk in students of nursing. Arch Intern Med 1968;121:545548.
4.Ehrenkranz, NJ, Kicklighter, JL, Tuberculosis outbreak in a general hospital: Evidence for airborne spread of infection. Ann Inlern Med 1972;77:377382.
5.Cantanzaro, A, Nosocomial tuberculosis. Am Rev Respir Dis 1982;125:559562.
6.Atuk, NO, Hunt, EH, Serial tuberculin testing and isoniazid therapy in general hospital employees. JAMA 1971;218:17951798.
7.Gregg, DB, Gibson, MS, Employee tuberculosis control in a predominantly tuberculosis hospital. J SC Med Assoc 1975;5:160165.
8.Craven, RB, Wenzel, RP, Atuk, NO, Minimizing tuberculosis risk to hospital personnel and students exposed to unsuspected disease. Ann Intern Med 1975;82:628632.
9.Ruben, FL, Norden, CW, Schuster, N, Analysis of a community hospital employee tuberculosis screening program 31 months after its inception. Am Rev Respir Dis 1977;115:2328.
10.Vogeler, DM, Burke, JP, Tuberculosis screening for hospital employees: A five-year experience in a large community hospital. Am Rev Respir Dis 1978;117:227232.
11.Bous, H, Duffy, KR, Hamory, BH, PPD conversion rales in an insurance company and a university hospital. Am J Infect Control 1984;12:247.
12.Holly, MP, Bartzokas, CA, Tuberculin testing in hospital personnel, J Hyg 1977;78:325329.
13.Berman, J, Levin, ML, Orr, ST, et al: Tuberculosis risk for hospital employees: Analysis of a five-year tuberculin skin testing program. Am J Public Health 1981;71:12171222.
14.Lowenthal, G, Keys, T, Tuberculosis surveillance in hospital employees: Are we doing too much? Infect Control 1986;7:209211.
15.Centers for Disease Control: Tuberculosis—North Dakota. MMWR 1979;27:523525.
16.Centers for Disease Control: Tuberculosis in a nursing care facility—Washington. MMWR 1983;32:121-122, 128.
17.Centers for Disease Control: Tuberculosis in a nursing home—Oklahoma. MMWR 1980;29:465467.
18.Stead, WW, Tuberculosis among elderly persons: An outbreak in a nursing home. Ann Intern Med 1981;94:606610.
19.Stead, WW, Lofgren, JP, Warren, E, et al: Tuberculosis as an endemic and nosocomial infection among the elderly in nursing homes. N Engl J Med 1985;312:14831487.
20.Narain, JP, Lofgren, JP, Warren, E, et al: Epidemic tuberculosis in a nursing home: A retrospective cohort study. J Am Geriatr Soc 1985;33:258263.
21.American Thoracic Society: Infectiousness of tuberculosis: A statement by the ad hoc committee on treatment of tuberculosis patients in hospitals. Am J Respir Dis 1967;96:836837.
22.Guidelines for Prevention of Tuberculosis Traitsmission in Hospitals. Atlanta, US Public Health Service, 1975.
23.Williams, WW, CDC guidelines for infection control in hospital personnel. Infect Control 1983;4:326349.
24.Price, LE, Rutala, WA, Samsa, GP, Tuberculosis in hospital personnel. Infect Control 1987;8:97101.
25.Thompson, NJ, Glassroth, JL, Snider, DE, et al: The booster phenomenon in serial tuberculin testing. Am Rev Respir Dis 1979;119:587597.
26.Tuberculosis Control Policies and Procedures. North Carolina Department of Human Resources, 1984.
27.Snider, DE, The tuberculin test, in Green, GM, Daniel, TM, Ball, WC (eds): Koch Centennial Memorial. New York, American Lung Association, 1982, pp 108118.
28.Lunn, JH, Administering and reading the Mantoux test, in Guidelines for the Diagnosis and Management of Tuberculosis Infection. New York, Audio Visual Medical Marketing Inc, 1984, pp 2025.
29.Kearns, TS, Cole, CH, Farer, LS, et al: Public health issues in control of tuberculosis: Surveillance techniques and the role of health care providers. Chest 1985;87(suppl):135138.
30.Welty, C, Burstin, S, Muspratt, S, et al: Epidemiology of tuberculosis infection in a chronic care population. Am Rev Respir Dis 1985;132:133136.
31.Barry, MA, Regan, AM, Kunches, LM, et al: Two-stage tuberculin testing with control antigens in patients residing in two chronic disease hospitals. J Am Geriatr Soc 1987;35:147153.
32.McGowan, JE, The booster effect—A problem for surveillance of tuberculosis in hospital employees. Infect Control 1980;1:147149.
33.Bass, JB, Serio, RA, The use of repeat skin tests to eliminate the booster phenomenon in serial tuberculin testing. Am Rev Respir Dis 1981;123:394396.
34.Valenti, WM, Andrews, BA, Presley, BA, et al: Absence of the booster phenomenon in serial tuberculin skin testing. Am Rev Respir Dis 1982;125:323325.
35.Simon, JA, McVickers, SJ, Ferrell, CR, et al: Two-step tuberculin testing in a veterans domiciliary population. South Med J 1983;76:866869.
36.Le, CT, Cost effectiveness of the two-step skin test for tuberculosis screening of employees in a community hospital. Infect Control 1984;5:570572.
37.Snider, DE, Cauthen, GM, Tuberculin skin testing of hospital employees: Infection, “boosting,” and two-step testing. Am J Infect Control 1984;12:305311.
38.Gross, TP, Israel, E, Powers, P, et al: Low prevalence of the booster phenomenon in nursing-home employees in Maryland. Md Med J 1986;35:107109.


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed