Determinants of Latent Tuberculosis Treatment Acceptance and Completion in Healthcare Personnel.

BACKGROUND: US public health strategy for eliminating tuberculosis (TB) prioritizes treatment of latent TB infection (LTBI). Healthcare personnel (HCP) are less willing to accept treatment than other populations. Little is known about factors associated with HCP LTBI therapy acceptance and completion. METHODS: We conducted a retrospective chart review to identify all employees with LTBI at time of hire at a large academic medical center during a 10-year period. Personal demographics, occupational factors, and clinic visit variables were correlated with LTBI treatment acceptance and completion rates using multivariate logistic regression. RESULTS: Of 470 HCP with LTBI for whom treatment was recommended, 193 (41.1%) accepted treatment, while 137 (29.1%) completed treatment. Treatment adherence was better with 4 months of rifampin than 9 months of isoniazid (95% vs 68%, P < .005). Increased age of the healthcare worker was independently associated with lower rates of treatment acceptance (odds ratio [95% confidence interval]: 0.97 [0.94-0.99] per year), as was having an occupation of clinician (0.47 [0.26-0.85]) or researcher (0.34 [0.19-0.64]). Male gender was associated with higher treatment acceptance (1.90 [1.21-2.99]). Treatment completion was associated with being from a low- (9.49 [2.06-43.73]) or medium- (8.51 [3.93-18.44]) TB-burden country. CONCLUSIONS: Geographic and occupational factors affect acceptance and completion of LTBI therapy. Short-course regimens may improve adherence. Physicians, researchers, and HCP from high-TB-burden countries have lower treatment rates than other HCP. Improving LTBI treatment in HCP will require attending to cultural and occupational differences.

Tuberculin Skin Test Conversions and Occupational Exposure Risk in US Healthcare Workers.

Background: Healthcare workers (HCWs) undergo occupational tuberculosis screening at regular intervals. However, the risk of contracting tuberculosis at the workplace in a setting with a low background tuberculosis incidence is unclear. We aimed to evaluate the risk of tuberculin skin test (TST) conversion and the risk of occupational tuberculosis infection among HCWs in such a setting. Methods: We conducted a retrospective cohort study of employees of a large tertiary medical center in the US Midwest who had undergone TST screening during the study period 1 January 1998 to 31 May 2014. Results: Among 40142 HCWs who received a TST, only 123 converted over 16.4 years. Only 9 (7%) of the converters had a suspected tuberculosis exposure at the workplace and none developed active tuberculosis. The majority of TST converters (66%) had a negative QuantiFERON-TB test at the time of the conversion. Conclusions: In one of the largest cohorts of HCWs in a low-tuberculosis-incidence setting, we demonstrated an extremely low risk of occupational tuberculosis exposure among TST converters and no resulting active tuberculosis cases. In this setting, the approach of testing HCWs at baseline and after tuberculosis exposure, rather than at regular intervals, should be considered.

COVID-19 Infections in Health Care Personnel by Source of Exposure and Correlation With Community Incidence.

OBJECTIVE: The aim of this study was to describe the rate of household, community, occupational, and travel-related COVID-19 infections among health care personnel (HCP). METHODS: In a retrospective cohort study of 3694 HCP with COVID-19 infections from July 5 to December 19, 2020, we analyzed infection source data and rates, compared with local and state infection rates, and performed a correlation analysis. RESULTS: Household (27.1%) and community (15.6%) exposures were the most common sources of infection. Occupational exposures accounted for 3.55% of HCP infections. Unattributable infections (no known exposure source) accounted for 53.1% and correlated with community rather than occupational exposure ( R = 0.99 vs 0.78, P < 0.01). CONCLUSIONS: COVID-19 infections in this large HCP cohort correlated closely with infection rates in the community. The low incidence of occupational infections supports the effectiveness of institutional infection prevention and control measures.

Community Health Needs Assessment Data and Community Recovery From COVID-19.

INTRODUCTION: The COVID-19 pandemic has had a significant impact beyond physical morbidity and mortality. A mid-cycle Community Health Needs Assessment survey was administered in 1 community to generate data to evaluate change in community well-being since the beginning of the pandemic. METHODS: Surveys were mailed to 2,000 randomly selected residents in Olmsetd County, Minnesota. The surveys included the WHO Well-being Index (previously included in the 2018 Community Health Needs Assessment) and new subjective questions regarding behavior change. Changes in well-being were calculated using a propensity-matched cohort, and behavior change was reported as proportions of the whole. Data analysis was completed in 2021. RESULTS: Total survey respondents were 569 people in 2018 and 723 people in 2021. Well-being scores from the WHO Well-being Index showed a statistically significant decrease (score reduction of -8.44) from 2018 to 2021. All the 5 questions from the WHO Well-being Index also had an individual significant decrease; with the question regarding interest in life showing the greatest decrease. Individuals reported decreased subjective physical and mental well-being and increased substance use (alcohol, marijuana, and tobacco). Households also reported decreased household incomes and worse household finances since the start of the pandemic. CONCLUSIONS: Using the Community Health Needs Assessment infrastructure, 1 community was able to compare prepandemic with postpandemic data, which showed decreased well-being and increased substance use and financial stress. Other public health planners can similarly conduct interval surveys on the basis of their Community Health Needs Assessment questionnaires to tailor ongoing Community Health Improvement Plan programming to postpandemic needs and track community mental health and well-being recovery.

Improving Collaboration Between Public Health and Medicine: A Timely Survey of Clinician Public Health Knowledge, Training, and Engagement.

OBJECTIVE: To assess the core knowledge of health indicators, federal health programs, and public health functions in practicing clinicians along with perceptions of their education and engagement with public health. PATIENTS AND METHODS: A paper survey in booklet form was administered to attendees at 2 general medical conferences in May 2019. The survey was divided into 5 sections: knowledge of health systems and policy, knowledge of public health concepts and function, public health engagement, public health education, and demographics. RESULTS: One hundred two surveys were received from 402 attendees (response rate, 24.3%). Most were male (56%), older than 50 years (51%), and physicians (86%). Respondents had a fairly good knowledge of federal health programs (77%) and public health functions (84%), but less than half had a personal interaction with public health in the past 2 years (45%) or were aware of how to work with public health organizations in their community (46%). Only a few respondents rated their public health training as good or excellent during their primary degree (7%) or graduate medical education (15%), and most (75%) were interested in learning more about public health and health policy. CONCLUSION: Respondents had generally good foundational knowledge of federal health programs and public health functions, although some gaps were identified. Inclusion of health policy and public health topics in continuing medical education would be well received by clinicians. To improve collaboration between public health and medicine, public health should personally engage clinicians more and explain how they can work together to improve population health.

Evaluating Well-being at Community Level.

OBJECTIVE: To measure well-being at a community level using a valid instrument. PATIENTS AND METHODS: Written surveys were mailed to a random sample of residents in Olmsted County, Minnesota, in 2015 and 2019 including the 5-item World Health Organization Well-being Index (0-100; for which 100 is the best imaginable well-being or quality of life). Multivariable hierarchical regression was used to evaluate the association between well-being and demographic characteristics, comorbid conditions, and environmental factors. RESULTS: The survey was returned by 1232 of 4000 individuals (response rate, 30.80%). The average well-being score was 70.02. Impaired well-being was identified in 223/1187 individuals (18.79%). Adjusted regression models showed that impaired well-being was independently associated with household poverty, financial stress, reduced access to medical or mental health care, ever having depression diagnosed, living in an unsafe community, or being socially isolated. CONCLUSION: One in 5 people in a county in the US Midwest have impaired well-being. Well-being was associated with several modifiable factors. Data provide a rationale for policies that align transportation and housing and create opportunities for community members to connect and interact in a safe environment.

Medical Surveillance Programs for Workers Exposed to Hazardous Medications: A Survey of Current Practices in Health Care Institutions.

OBJECTIVE: To assess current medical surveillance monitoring practices for health care workers who prepare, handle, or administer hazardous medications. METHODS: A cross-sectional survey was distributed to members of the American College of Occupational and Environmental Medicine and the National Comprehensive Cancer Network. RESULTS: Forty-six of the 91 survey respondents indicated that their institution had a hazardous medication surveillance program. We identified the most frequent laboratory (complete blood count) and physical (skin) examination components. A health history was frequently used. Statistical analysis did not suggest an association between institutions with greater resources and presence of a surveillance program. CONCLUSIONS: A consensus standard for medical monitoring was not reported by the respondents. We recommend using a standardized surveillance questionnaire and applying uniform laboratory testing across institutions, in addition to establishing a national repository for surveillance data.

Have you had a tetanus booster in the last 10 years? Sensitivity and specificity of the question.

OBJECTIVE: To evaluate the accuracy of patients' recall of their last Tetanus/Diphtheria (Td) booster in the setting of employee health clinics known for high immunization rates and good documentation of vaccine status. METHODS: Five hundred and seventy-two patients of an employee health clinic answered a written questionnaire about whether they have had a Td booster in the last 10 years. Answers were compared with patients' charts as the gold standard. RESULTS: The sensitivity of the question is 92.4% (95% CI 89.0-95.0) and specificity is 26.5% (95% CI 12.9-44.4). Positive predictive value is 92.6% (95% CI 89.3-95.2) and negative predictive value is 25.7% (95% CI 12.5-43.3). Age and gender do not affect the accuracy of recall. CONCLUSION: A positive answer to this question is highly reliable whereas a negative answer is unreliable. PRACTICE IMPLICATIONS: In the setting of employee health clinics, when patients affirm the receipt of a Td booster within the previous 10 years, it is quite likely that they are up to date and do not require re-administration of the vaccine. Any other answer to this question (No, I do not know) is unreliable and a booster should be recommended if not contraindicated.

Medical Surveillance for Hazardous Drugs: A Qualitative Assessment of Current Practices.

OBJECTIVE: The National Institute for Occupational Safety and Health recommends that institutions establish a medical surveillance program for workers who handle hazardous drugs. Our aim was to investigate current practices with occupational medicine practice (OMP) national leaders. METHODS: A series of qualitative telephone interviews were conducted with 11 OMP national leaders from medical centers in 10 states. Interviews were recorded, transcribed, and coded using a directed content analysis. Codes were organized into themes. RESULTS: All respondents were board-certified physicians in medical center OMP. Interviews up to 45 minutes found three themes: policy interpretation, benefits and barriers to surveillance, and potential respondent-generated solutions. Three of 10 medical centers provided medical surveillance. CONCLUSIONS: Medical surveillance for hazardous drugs is infrequent, and consensus is lacking regarding standard practices. Further work is needed to minimize risk to health care workers.

Self-report of tobacco use status: comparison of paper-based questionnaire, online questionnaire, and direct face-to-face interview--implications for meaningful use.

Identifying tobacco use status is essential to address use and provide resources to help patients quit. Being able to collect this information in an electronic format will become increasingly important, as the Centers for Medicare and Medicaid Services has included the assessment of tobacco use as part of its Stage 1 Meaningful Use criteria. The objective was to compare the accuracy of online vs. paper assessment methods to ascertain cigarette smoking status using a face-to-face structured interview as the gold standard. This was a retrospective analysis of a stratified opportunity sample of consecutive patients, reporting in 2010 for a periodic health evaluation, who completed either a scannable paper-based form or an online questionnaire and underwent a standardized rooming interview. Compared with face-to-face structured interview, the overall observed agreement and kappa coefficient for both methods combined (paper and online) were 97.7% and 0.69 (95% confidence interval (CI) 0.51-0.86) . For the online form they were 97.4% and 0.61 (95% CI 0.33-0.90), and for the paper form they were 97.9% and 0.75 (95% CI 0.54-0.96). There was no statistically significant difference in agreement between the online and paper-based methods (P=0.76) compared with a face-to-face structured interview. Online assessment of tobacco use status is as accurate as a paper questionnaire, and both methods have greater than 97% observed agreement with a face-to-face structured interview. The use of online assessment of tobacco use status has several advantages and more widespread use should be explored.

Protective eyewear selection for interventional fluoroscopy.

Three protective eyewear models were evaluated to determine effectiveness in reducing radiation dose to a fluoroscopist's eyes. The performance of the protective eyewear was measured using radiation dosimeters in a fluoroscopy suite. An Eyewear Protection Factor was determined for each model in each of three exposure orientations. The protection was strongly influenced by the location of the radiation source. When the source was in front of the fluoroscopist, the lead equivalence was important. When the source was to the side of the fluoroscopist, the cross section of the side shield had a significant influence on protection. Protective eyewear selection needs to include consideration of job task and head orientation to the radiation source as well as the possibility that face shape and eyewear fit may also impact the radiation dose to the eye.

Is an occupational examination superior to an occupational health history alone for preplacement screening in health care settings?

OBJECTIVES: To determine whether preplacement recommendations following an occupationally focused medical history is different from those following an occupational consultation. METHODS: This was a retrospective cohort study of 172 applicants to our institution. RESULTS: Following provider review of occupational history survey alone, none of the applicants had restrictions recommended. In comparison, only 163 applicants (94.7%) were recommended to be hired without restrictions following provider review of the same patient's occupational history and examination (P = 0.0078). CONCLUSION: A well-designed questionnaire is useful for screening applicants for preplacement examinations and assures sufficient detail to allow for a large proportion of individuals to proceed to employment without an occupational examination. However, in this study, a small but statistically significant portion (5%) of applicants required occupational examinations for appropriate work recommendations.

Preemployment screening for tuberculosis in a large health care setting: comparison of the tuberculin skin test and a whole-blood interferon-γ release assay.

OBJECTIVE: Determine the performance of an interferon-γ release assay in a health care occupational surveillance program. METHODS: From January 11, 2005, through January 31, 2006, all new employees (n = 652) undergoing standard, preemployment evaluation at Mayo Clinic, Rochester, Minnesota were evaluated for tuberculosis using a standard process of symptom screening combined with tuberculin skin test (TST) and QuantiFERON-TB Gold test (QFT-G). RESULTS: Comparing the results of QFT-G directly to TST, QFT-G showed an overall agreement of 92.5%. CONCLUSIONS: False-positive TST were the most significant issue affecting agreement, and in a low-tuberculosis prevalence population, the need for an effective strategy offering low false-positive results may be best met by combining the TST with QFT-G.