Effectiveness of Two-Step Tuberculin Skin Testing in Hospital Employees

Abstract

Objective: To review the literature discussing the use of two-step tuberculin skin testing for hospital employees. Data Sources: English-language journal articles involving human subjects. Study Selection: Selected articles describing the use of two-step tuberculin skin testing. Data Extraction: Information relevant to the topic was extracted from the articles and synthesized into this report. Data Synthesis: People infected with tuberculosis exhibit a skin-test reaction to tuberculin, but this reaction can diminish over time. A two-step tuberculin skin test involves the administration of a second injection of tuberculin 1–3 weeks after the initial injection. The rationale for the use of the two-step tuberculin skin test is to help differentiate between individuals with new tuberculosis infections and those with previous infections whose immune response to tuberculin had decreased to levels not detectable with a single skin test. Conclusions: Two-step tuberculin skin testing is effective at detecting a booster effect. Despite the recent mandate by the Occupational Safety and Health Administration to use two-step tuberculin testing in all healthcare facilities, such testing may not be cost-effective in institutions with young employees, high employee turnover, and a low risk of tuberculosis. The requirements for universal two-step tuberculin testing may need to be reevaluated to account for these factors.