Interpretation and Documentation of TB testing results (QFT and TST)
April 2013 revision
Preplacement: Healthcare Worker with history of positive TST or QFT prior to hireTB Test / QFT Results / Follow-up / Documentation in Agility
+QFT Prior to Hire / QFT +history prior to hire
Documentation provided / · Order CXR
· If level ≥ 1.11 consider positive and no further retesting required.
· If no level or level ≤ 1.10, retest during preplacement assessment / · VISIT: Preplacement
· Click on Encounter
· For documented levels ≥1.11:
o Medical Activity: TB-QFT+ PTH
o Code: +
o Meaning: >/=1.11
o Summary: HX QFT+ PTH
QFT #1
Draw QFT #1:
· On all new hires with history of +TST or +QFT (without documentation of QFT ≥ 1.11) / Negative
≤ 0.34 / · Requires annual QFT at time of annual health screen
· Refer to RN/ARNP if HCW has questions.
· EHS RN/LPN notifies HCW that QFT is negative
· Order CXR by ARNP / · VISIT: Preplacement
· Click on Encounter
· Medical Activity: TB- QFT #1 Preplacement
o Code: –
o Meaning: </=O.34
o Summary: HX TST +PTH/QFT- then enter actual level
Negative
0.35 – 1.10 / · Order CXR by ARNP
· If no risk factors: retest on next annual
· EHS RN/LPN notifies HCW that QFT is negative
· If any +risk factors: retest in 10 weeks
· Risk Factors:
o Travel to area with endemic TB in past 12 months
o Exposed to TB in past 12 months
o TB symptom check + / · VISIT: Preplacement
· Click on Encounter
· Medical Activity: TB-QFT#1 Preplacement
o Code: N for no risk
o Code: D for high risk
o Meaning: .35-1.10 NR for those without risk factors or 0.35-1.10 HR for those with risk factors
o Summary: Enter HX TST+ PTH/QFT- then enter actual level
Positive
≥ 1.11 / · Order CXR by ARNP
· EHS LPN/RN notifies HCW
· HCW must make an appt with EHS ARNP
· EHS RN or ARNP reviews signs and symptoms of TB with HCW and documents history of TB exposures or risk factors on “TB Test Evaluation Form”
· Requires symptom screen on annual / · VISIT: Preplacement
· Click on Encounter
· Medical Activity: TB- QFT #1 Preplacement
o Code: +
o Meaning: >/=1.11
o Summary: HX TST+ PTH/QFT+ then enter actual level
Indeterminate
(lab unable to determine level) / · Order CXR by ARNP
· EHS LPN/RN notifies HCW to return to EHS to check a second QFT in 10 weeks / · VISIT: Preplacement
· Click on Encounter
· Medical Activity: TB- QFT #1 Preplacement
o Code: I
o Meaning: Indeterminate
o Summary: HX TST+ PTH/ indeterminate QFT
QFT # 2
Draw for:
· Indeterminate on QFT #1
· 10 week redraw for Level 0.35-1.10 with risk factors / Negative
≤ 0.34 / · EHS RN/LPN notifies HCW that QFT is negative
· Requires annual QFT during annual health screen / · VISIT: Blood Draw Miscellaneous
· Click on Encounter
· Medical Activity: TB-QFT #2 preplacement
o Code: -
o Meaning: </= 0.34
o Summary: HX TST+ PTH/QFT – then enter actual level
Negative
0.35-1.10 / · Redraw QFT on annual screen / · VISIT: Blood Draw Miscellaneous
· Click on Encounter
· Medical Activity: TB-QFT#2 Preplacement
o Code: N for no risk
o Code: D for high risk
o Meaning: .35-1.10 NR for those without risk factors or 0.35-1.10 HR for those with risk factors
· Summary: Enter HX TST+ PTH/QFT- then enter actual level
Positive
≥ 1.11 / · EHS LPN/RN notifies HCW
· HCW must make an appt. with EHS ARNP
· EHS ARNP evaluates employee for prophylaxis and documents
· TB symptom screen with annual screening
· No further TB testing required / · VISIT: Blood Draw Miscellaneous
· Click on Encounter
· Medical Activity: TB- QFT #2 Preplacement
o Code: +
o Meaning: >/=1.11
o Summary: TST+ PTH/QFT+ then enter actual level
Indeterminate
(lab unable to determine level) / · If second blood draw is indeterminate on new employee with +TST history:
o Review symptom screen to ensure employee does not have symptoms of TB
o Redraw QFT on next annual screen
· Consider TST if new employee did not provide documentation of TST+ history / · VISIT: Blood Draw Miscellaneous
· Click on Encounter
· Medical Activity: TB- QFT #2 Preplacement
o Code: I
o Meaning: Indeterminate
· Summary: HX TST+ PTH/ indeterminate QFT
Preplacement: Healthcare Worker with a history of a negative TST and/or negative QFT prior to hire
TB Test / Results / Follow-up / Documentation in Agility
QFT #1
Draw QFT on all new hires in this category / Negative
≤ 0.34 / · No further follow-up
· Requires annual TST / · VISIT: Preplacement
· Click on Encounter
· Medical Activity: TB-QFT #1 Preplacement
o Code: -
o Meaning: </=0.34
o Summary: HX TST- PTH/QFT- then enter actual level
Negative
0.35-1.10 / · If no risk factors: retest on annual
· If any +risk factors: retest in 10 weeks
· Risk Factors:
o Travel to area with endemic TB in past 12 months
o Exposed to TB in past 12 months
o TB symptom check + / · VISIT: Preplacement
· Click on Encounter
· Medical Activity: TB-QFT#1 Preplacement
o Code: N for no risk
o Code: D for high risk
o Meaning: .35-1.10 NR for those without risk factors or 0.35-1.10 HR for those with risk factors
· Summary: Enter HX TST- PTH/QFT- then enter actual level
Positive
≥ 1.11 / · CXR
· EHS RN notifies patient of positive result and makes appointment with EHS ARNP
· EHS ARNP reviews HCW risk factors and symptom screen
· Evaluates for prophylaxis / · VISIT: Preplacement
· Click on Encounter
· Medical Activity: TB-QFT #1 Preplacement
o Code: +
o Meaning: >/=1.11
o Summary: HX TST- PTH/QFT+ and add actual level in summary
Indeterminate
(lab unable to determine level) / · EHS LPN/RN notifies HCW to return to EHS to check a second QFT in 8 weeks / · VISIT: Preplacement
· Click on Encounter
· Medical Activity: TB- QFT #1 Preplacement
o Code: I
o Meaning: Indeterminate
· Summary: HX TST- PTH/ indeterminate QFT
QFT # 2
Draw QFT #2 for:
· Persons with indeterminate level on QFT #1
Wait 10 weeks after 1st QFT
· Persons with levels between 0.35-1.10 with risk factors on QFT #1. Redraw in 10 weeks / Negative
≤ 0.34 / · RN/ARNP informs HCW that 2nd QFT is negative
· Annual TST required
· Review CXR results / · VISIT: Blood Draw Miscellaneous
· Click on Encounter
· Medical Activity: TB-QFT #2 Preplacement
o Code: -
o Meaning: </=0.34
o Summary: HX TST-/QFT- and include QFT level
Negative
0.35-1.10 / · Redraw QFT on next annual screen
· EHS RN/ARNP informs HCW of results / · VISIT: Blood Draw Miscellaneous
· Click on Encounter
· Medical Activity: TB-QFT#2 Preplacement
o Code: N for no risk
o Code: D for high risk
o Meaning: .35-1.10 NR for those without risk factors or 0.35-1.10 HR for those with risk factors
· Summary: Enter HX TST- PTH/QFT- then enter actual level
Positive
≥ 1.11 / · EHS RN/ ARNP meets with HCW to discuss positive results and complete TB symptom screen
· HCW given written educational materials on TB and INH therapy
· Consider treatment with INH therapy
· Annual symptom screen / · VISIT: Blood Draw Miscellaneous
· Click on Encounter
· Medical Activity: TB-QFT #2 Preplacement
o Code: +
o Meaning: >/= 1.11
· Summary: HX TST-PTH/QFT+ then enter actual level
· If considered true positive/conversion; document incident as TB-Conversion preplacement (ask ARNP??)
Indeterminate / · If second blood draw is indeterminate on new employee with - TST or -QFT history:
o Review symptom screen to ensure employee does not have symptoms of TB
o Draw QFT on next annual screen
· Consider TST based on patient history / · Visit : Blood Draw Miscellaneous
· Click on Encounter
· Medical Activity: QFT #1 Preplacement
o Code: I
o Meaning: Indeterminate
o Summary: HX TST-PTH/Indeterminate QFT
Annual Screen/Other: Healthcare Worker with history of negative TST with negative QFT on Preplacement/Other
TB Test / Results / Follow-up / Documentation in Agility
TST
Place TST in this category for:
· All persons with history negative TST with negative preplacement QFT / Negative
≤ 9mm / · Annual TST
· Annual symptom screen / · Visit: Annual Screen
· Click Encounter
· Medical Activity: TB- TST Annual
o Code:
o Meaning
o Summary:
Positive
≥ 10mm / · CXR ordered
· QFT ordered
· Measure TST induration and document in Agility
· Draw QFT to confirm TST+ result / · Visit: Annual Screen
· Click Encounter
· Medical Activity: TB-TST Annual
o Results: + Positive
o Summary: Record induration in mm
QFT #1
Draw QFT on annual in this category for:
· Persons with new TST + (≥ 10mm) on annual health screen / Negative
≤ 0.34 / · Annual QFT
· Annual symptoms screen / · Visit: ???
· Click Encounter
· Medical Activity: TB-QFT #1 Annual Screen
o Code: -
o Meaning: </=0.34
o Summary: TST HX + or -/QFT-
Negative
0.35-1.10 / · If no risk factors: retest on annual
· If any +risk factors: retest in 8 weeks
· Risk Factors:
o Travel to area with endemic TB in past 12 months
o Exposed to TB in past 12 months
o TB symptom check + / ·
Positive
≥1.11 / · EHS RN/ ARNP meets with HCW to discuss positive results and complete TB symptom screen
· HCW given written educational materials on TB and INH therapy
· Consider treatment with INH therapy
· Annual symptom screen / · Visit: Blood Draw Miscellaneous
· Click Encounter
· Medical Activity: TB-QFT #1 Annual Screen
o Code: +
o Meaning: +/=1.11
o Summary: TST HX +/QFT+AS
· If determined true positive/new conversion document incident as TB-Conversion Annual
Indeterminate / · EHS LPN/RN notifies HCW to return to EHS to check a second QFT in 4-6 weeks / ·
QFT #2
Draw QFT #2 in this category for:
· All persons with QFT #1 level 0.35-1.10
· All persons with QFT #1 indeterminate / Negative
≤ 0.34 / · Annual QFT
· Annual symptom screen / · Visit: Blood Draw Miscellaneous
· Click Encounter
· Medical Activity: TB-QFT #2 Annual Screen
o Code: -
o Meaning: </=0.34
o Summary: TST HX -/QFT -
Negative
0.35-1.10 / · Retest on next annual health screen / ·
Positive
≥1.11 / · EHS RN/ ARNP meets with HCW to discuss positive results and complete TB symptom screen
· HCW given written educational materials on TB and INH therapy
· Consider treatment with INH therapy
· Annual symptom screen
· CXR if not already ordered / · Visit: Blood Draw Miscellaneous
· Click Encounter
· Medical Activity: TB-QFT #2 Annual Screen
o Code: +
o Meaning: >/=1.11
o Summary: TST -/QFT + new AS
Indeterminate
#2 / · If second blood draw is indeterminate on new employee with - TST or -QFT history:
o Review symptom screen to ensure employee does not have symptoms of TB
· Draw QFT on next annual screen / ·
Annual Screen: Healthcare Worker with history of Positive TST and Negative QFT
TB Test / Results / Follow-up / Documentation in Agility
QFT #1
Draw QFT #1 in this category for:
· Persons with a history of +TST and –QFT / Negative
≤ 0.34 / · Annual QFT
· Annual symptoms screen / · Visit: Annual Screening
· Click Encounter
· Medical Activity: TB QFT #1 Annual Screen
o Code: -
o Meaning: </=0.34
o Summary: TST HX +/QFT-
Negative
0.35-1.10 / · If no risk factors: retest on annual
· If any +risk factors: retest in 8 weeks
· Risk Factors:
o Travel to area with endemic TB in past 12 months
o Exposed to TB in past 12 months
o TB symptom check + / ·
Positive
≥ 1.11 / · EHS RN/ ARNP meets with HCW to discuss positive results and complete TB symptom screen
· HCW given written educational materials on TB and INH therapy
· Consider treatment with INH therapy, depending on history. Consult with ID physician as necessary.
· Annual symptom screen
· Annual testing not required
· CXR if not already ordered / · Visit: Annual Screening
· Click Encounter
· Medical Activity: TB-QFT #1 Annual Screen
o Code: +
o Meaning: ./=1.11
o Summary: TST HX +/
· If determined true positive/new conversion document incident as TB-Conversion Annual Screen
Indeterminate
#1
(lab unable to determine level) / · EHS LPN/RN notifies HCW to return to EHS to check a second QFT in 4-6 weeks / ·
QFT #2
Draw QFT #2 in this category for:
· Persons with QFT #1 0.35-1.10
· Persons with indeterminate on QFT #1 / Negative
≤ 0.34 / · Annual QFT
· Annual symptom screen / · Visit: Blood Draw Miscellaneous
· Click Encounter
· Medical Activity: TB-QFT #2 Annual Screen
o Results: - Negative
o Summary: TST HX/QFT-
Negative
0.35-1.10 / · Retest on annual health screen / ·
Positive / · Review CXR results
· If determined to be true positive/new conversion document incident as TB-Conversion Annual Screen
· Consider INH therapy / · Visit: Blood Draw Miscellaneous
· Click Encounter
· Medical Activity: TB-QFT #2 Annual Screen
o Results:+ Positive
o Summary: TST HX/QFT+
Indeterminate
#2 / · If second blood draw is indeterminate on new employee with - TST or -QFT history:
o Review symptom screen to ensure employee does not have symptoms of TB
o Draw QFT on next annual screen / o
Annual Screen: Healthcare Worker with history of documented positive QFT (≥1.11)
TB Test / Results / Follow-up / Documentation in Agilty
None
NO TST or QFT required / N/A / · Symptom Screen on annual screen form
· Refer to RN/ARNP for any positive symptoms
· If any positive symptoms will order CXR / · Visit: Annual Screen
Immunocompromised Healthcare workers
· Immunocompromised healthcare workers include: Persons who are HIV+, persons with
· Immunocompromised healthcare workers will be informed that the results of the TST and/or QFT test may be inaccurate.
· EHS RN or ARNP will ascertain state of immune function and document
· CXR will be ordered annually on immunocompromised persons
· Annual review of TB symptoms will be performed
· Positive TB conversions will be treated according to protocol
· ID physicians will be consulted as appropriate.
Post-Exposure TB Testing if prior negative TST or QFT
TB Test / Results / Follow up / Documentation in Agility
QFT # 1 / Negative
≤ 0.34 / · Follow up in 10 weeks for post exposure testing / · Visit: TB-QFT 10 week postexp F/U
· Click Encounter
· Medical Activity: #1 Quantiferon Exp 10 week post exposure
·
Negative
0.35-1.10 / · Retest 10 week post exposure / ·
Positive
≥1.11 / · Evaluation by EHS ARNP
· Consider prophylaxis therapy, if indicated
· CXR / · Visit :TB-QFT 10 week post exp F/U
· Click Encounter
· Medical Activity: #1 Quantiferon Exp 10 week post exposure
o
Indeterminate / · Retest in 10 weeks / ·
10 week post exposure QFT / Negative
≤0.34 / · No further action
· Annual TB testing / · Visit: TB-QFT 10 week post exposure F/U
· Click Encounter
Negative
0.35-1.10 / · Retest on next annual screen / ·
Positive
≥1.11 / · Evaluation by EHS ARNP
· Consider prophylaxis therapy, if indicated
· Document as conversion, if indicated / · Visit :TB-QFT 10 week post exp F/U
· Click Encounter
· Medical Activity: #2 Quantiferon Exp 10 week post exposure
o Results: + Positive
o Summary: TST HX /QFT+
Indeterminate #2 / · TST if person with history negative TST
· If history +TST, retest with QFT on next annual / ·
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