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Annual Testing if TST Positive?

Q: Should employees who have positive PPDs continue to be tested yearly? Do they need to have a chest x-ray every year?

A: You do not need to ever repeat the PPD skin test for employees who have tested positive. Perform a chest x-ray after the first positive PPD, but do not repeat it yearly unless the employee:

* Is a recent converter
* Is a close contact of someone with TB
* Has a medical condition that increases his/her risk for TB
* Injects drugs

Need help with OSHA compliance? Ask Dr. Dunn or browse our helpful osha manuals & compliance programs.

Posted by Quality America on December 30, 2005 | Comments (6)


I have become the new OSHA rep for my office and I am trying to bring it up to date with all the new policies. If I remember from my old office were I helped some, we had to have annual ppd testing. Is this accurate? I am having trouble finding the answer. Thank you for your help.

Posted by: Anna-Christy Carson at June 8, 2006 10:03 PM

Based on the December 30, 2005 CDC TB guidelines, the first thing you should do is determine which of the 3 risk categories your practice falls into. To do a risk assessment, contact your local heath department for the number of TB patients (and relative risk) in your community. Also, determine how many TB patients entered your practice last year. If you encountered less than 3 TB patients, your practice is considered low risk. No annual Tuberculin Skin Testing (TST) is required for low risk practices, however ensure that you conduct a two-step TST for new employees. For more details on managing your practice's TB plan and the CDC's new revisions, check out Quality America's Audioconference CD on Protecting Healthcare Workers from Respiratory Infections such as TB and Flu.

Posted by: Sarah Alholm at June 12, 2006 11:43 AM

I think in addition to criteria above, if the employee exhibits signs and symptoms of active tuberculosis then xrays or additional diagnostic testing, ie sputums should be done. This evaluation should be done annually or if the employee is noticeabley sick with tb symptoms during the course of the year.

Posted by: brian at September 8, 2006 01:56 PM

Thanks Brian! We agree that whenever the employee has signs or symptoms consistent with active TB, diagnostic testing is called for. Annually, it's a good idea to review the indicators of active TB disease with the employee. We believe an annual chest x-ray isn't necessary unless the employee is symptomatic, or meets one of the other conditions set out above. Of course, per the CDC, managing TB patients is the purview of local public health departments, so check with your local public health officer to see what is required in your community.

Posted by: Sarah Alholm at September 20, 2006 03:15 PM

I had positive PPD test and was treated for lung TB in 1998. The doctor tested me for PPD in a routine exam yesterday without asking if I had a positive before. I am also breastfeeding, is my baby at any risk and am I at any risk just because I repeated a PPD.

Posted by: maya at June 25, 2007 09:46 AM

Unfortunately, I am not your medical care provider and therefore cannot know if certain circumtances that increase your risk are present in your situation. If you've tested poitive in the past you should not have a repeat PPD test because there's a small risk of severe redness and swelling in the arm of those who have had a previous positive PPD test and undergo repeat testing.

In the future be sure to inform your health care provider that you've had a positive PPD skin test and been treated for TB, even if they don't ask. Take charge of your health and don't allow yourself to have a test you know you don't need! Call your doctor and explain that you're concerned about having had the repeat PPD, if you have severe redness or swelling get follow-up medical care immediately.

Posted by: Sarah Alholm at June 27, 2007 10:34 AM

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