Follow-up of tuberculin skin test positive hospital employees

Little is documented on what happens to employees who are found to be TST positive (e.g., how many are prescribed INH and who is compliant?). We followed all employees with a new positive TST from April 1995 through October 1996 at Barnes-Jewish Hospital, a 1700 bed university-affiliated tertiary referral center. All employees and volunteers receive a TST at hire and annually thereafter. Employees with a positive test (≥5mm for those with HIV or recent exposure to TB, ≥10mm otherwise) received a chest radiograph and saw an MD for evaluation regarding INH preventative therapy. INH is provided for free, and an occupational health nurse followed up with each patient monthly. 154 TST positive employees were seen. 91 (59%) were female; 63 (41%) were African-American, and 65 (42%) were white. 49 (32%) were foreign born. 14 (9%) were MDs, and 14 (9%) were nurses. 57 (37%) of tests were positive on initial employment screening; 77 (50%) were new TST conversions. 18 (12%) employees had an abnormal chest radiograph, but no cases of active TB were found. Preventative therapy was recommended for 133 (86%) employees, of whom 8 refused. 83/125 (66%) of those who agreed to take preventative therapy finished their regimen. Those with a positive test at employment were less likely to finish than those found at annual testing (22/43 vs. 59/82, P=.034). MDs were more likely to refuse (3/14 vs. 5/119, P=.038) and less likely to finish (4/11 vs. 77/114, P=.05) preventative therapy than other employees. Nurses were the most likely to finish (12/13 vs. 69/112, P=.032). Overall compliance with preventative therapy was fair, and should be improved, especially among MDs.