October 15, 2013
ALTSA: NH #2013-020
RECURRENT NATIONWIDE SHORTAGE
OF TUBERCULIN SKIN TEST ANTIGEN SOLUTIONS
Dear Nursing Facility/Home Administrator and Interested Parties:
In April of 2013, the Centers for Disease Control (CDC) reported that TUBERSOL®, a purified protein derivative (PPD) solution used in administering skin tests for tuberculosis (TB), was in shortage nationwide. The shortage is expected to last until at least the middle of October 2013. Once the shortage is over, it is anticipated that it will remain difficult to obtain the solution while widespread distribution is reinstated.
While the shortage is ongoing and supply is difficult to obtain, the Department of Health (DOH), recommends one of the following approaches to TB testing:
- Perform risk-based TB screening. Persons who would typically receive a TB test can be screened using a TB risk assessment and symptom screening. If the risk assessment or symptom screening indicate TB testing is necessary, then TB testing (TST or IGRA) must be performed. If the risk assessment and symptom screening are negative, defer TB testing until PPD solution can be obtained. See attachment for a sample TB Risk Assessment and Symptom Screening form.
- Substitute Interferon-Gamma Release Assays (IGRA) blood tests for tuberculin skin tests (TSTs). The two available tests are Quantiferon Gold In-tube® or T-Spot®. While the cost associated with using the blood tests can be greater than the cost of TST, the IGRAs have higher specificity than TSTs and are less likely to give false positive results. For more information on performing IGRA blood tests please call the DOH TB Program at 360-236-3431.
The following links are available on the ALTSA NH Professionals webpage at http://www.aasa.dshs.wa.gov/professional/nh.htm under "Tuberculosis Resources":
- the CDC notification;
- the risk based TB screening; and
- the DOH webpage for updates on the TB solution availability
If you have any questions about the TB shortage of solutions related to inspection/complaint investigation issues, please contact your RCS Field Manager.
Sincerely,
E. Irene Owens, Interim Director
Residential Care Services