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Real and Apparent Tuberculin Skin Test Conversions in a Group of Medical Students

Published online by Cambridge University Press:  02 January 2015

Rebecca Wurtz*
Affiliation:
Divisions of Infectious Disease, University of Illinois School of Public Health, Chicago, Illinois Hospital Epidemiology, University of Illinois School of Public Health, Chicago, Illinois
Jose Fernandez
Affiliation:
Divisions of Infectious Disease, University of Illinois School of Public Health, Chicago, Illinois
Borko Jovanovic
Affiliation:
Cook County Hospital, and the Division of Epidemiology-Biostatistics, University of Illinois School of Public Health, Chicago, Illinois
*
CCSN 1028, Cook County Hospital, 1835 W Harrison, Chicago, IL 60612

Abstract

Objective:

To evaluate tuberculin skin test (TST) conversions among a group of medical students.

Design:

Questionnaire sent to a medical school class in whom a cluster of TST conversions was noted, and interview and repeat TST of students with conversion.

Setting:

County hospital and associated medical school.

Subjects:

Medical students, after their third year in medical school.

Results:

Of 165 students in the class, 115 (70%) responded; 10 reported TST conversions between the beginning of the third and the fourth year. Seven of 10 were interviewed, and all 10 were retested. Five students, all in a cohort who tested each other during a clinical clerkship with a tuberculin material previously reported to be associated with a high rate of false-positive TSTs, were TST negative on repeat. Five had persistently positive TSTs. One was exposed during a psychiatry clerkship to a resident with pulmonary tuberculosis. Four students appeared to have converted their TST during their third year in medical school. All four did their medicine clerkship at a large county hospital (P<0.02; odds ratio = 16.4) that had few infection control measures in place for tuberculosis isolation during the time of their exposure.

Conclusions:

We recommend that medical students, as well as other healthcare professions students, be educated about infection control practices and skin tested at least annually during clinical training years.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1994

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References

1. Centers for Disease Control. Nosocomial transmission of mul-tidrug-resistant tuberculosis to health-care workers and HIV-infected patients in an urban hospital-Florida. MMWR 1990;39:718722.Google Scholar
2. Cocchiarella, L, Cohen, R, Muzaffar, S. PPD conversion among housestaff in a public hospital. Am Rev Respir Dis 1992; 145 (suppl):A102. Abstract 467.Google Scholar
3. Wurtz, R, Dolan, M, O'Neal, B, Azarcon, E. Infection control instruction and screening for students. Am J Infect Control. In press.Google Scholar
4. Israel, HL, Hetherington, HW, Ord, JG. A study of tuberculosis among students of nursing. JAMA 1941;117:839844.CrossRefGoogle Scholar
5. Weiss, W. Tuberculosis in student nurses at Philadelphia General Hospital. Am Rev Respir Dis 1973;107:136139.Google Scholar
6. Brean, HP, Kane, LW. Pulmonary tuberculosis in Harvard medical students. N Engl J Med 1946;235:315321.CrossRefGoogle ScholarPubMed
7. Craven, RB, Qenzel, RP, Atuk, NO. Minimizing tuberculosis risk to hospital personnel and students exposed to unsuspected disease. Ann Intern Med 1975;82:628632.CrossRefGoogle ScholarPubMed
8. Chan, JC, Tabak, JI. Risk of tuberculous infection among house staff in an urban teaching hospital. S Med J 1985;78:10611064.CrossRefGoogle Scholar
9. Malasky, C, Jordan, T, Potulski, E Reichman, LB. Occupational tuberculosis infections among pulmonary physicians in training. Am Rev Respir Dis 1990;142:505507.CrossRefGoogle ScholarPubMed
10. Bickel, D. Tuberculin conversion in Indochina refugees. JAMA 1983;250:1978.Google Scholar
11. Fauerbach, LL, Boeff, D, Shands, JW, Gutekunst, RR. Product variance in PPD positivity rate. Infect Control Hosp Epidemiol 1993; 14:439.Google Scholar
12. Lifson, AR, Watters, JK, Thompson, S, Crane, CM, Wise, E Discrepancies in tuberculin skin test results with two commercial products in a population of intravenous drug users. /Infect Dis 1993;168:10481051.Google Scholar
13. Tager, IB, Kalaidjian, R, Baldini, L, Rocklin, RE. Variability in the intradermal and in vitro lymphocyte responses to PPD in patients receiving isoniazid chemoprophylaxis. Am Rev Respir Dis 1985;131:214220.Google Scholar
14. Fagan, MJ, Poland, GA. Tuberculin skin testing in medical students: a survey of U.S. medical schools. Ann Intern Med 1994;120:930931.Google Scholar