Clinical Audit of Tuberculosis Prescreening, Latent TB identification and Treatment prior to Biologic Commencement
Harkins P, Shah Q, Camon A, Wheelan E, Mohammad A, O'Rourke K
Midlands Regional Hospital Tullamore
The advent of biologics has revolutionized the management of chronic inflammatory disease. However, these therapies are not without potential risk including the risk of infection in particular the possible development of Tuberculosis.
Screening of latent TB infection (LTBI) is thus necessary prior to their initiation.
The aims of this study were to assess our compliance with screening recommendations prior to the initiation of biologics in our institution. We also wished to identify the prevalence of LTBI among this patient cohort and assess the number of these patients who underwent preventative treatment and rescreening.
An audit was conducted over a one month period in December 2018. A retrospective database containing patients commenced on a biologic was utilized to identify the patient cohort. Clinic letters were then used to analyze the documentation of Chest X-ray (CXR) and Tuberculin Skin Test (TST)/ Interferon Gamma Release Assay (IGRA) performed as a prescreen.
They were also used to identify the cases in which LTBI was found and the documented number of cases treated for LTBI. We also audited the number of cases rescreened following treatment and an initial positive screen.
A total of 643 people were identified.
Of those 635 (99%) had documentation of CXR performed.
605 (94%) had documentation of IGRA/TST.
The diagnosis of LTBI was established in 86 (13%).
Of those documented to have LTBI, 14 (16%) failed to have documentation of preventative treatment.
65 (76%) had documentation of rescreening post treatment.
Of interest 11 (17%) of those rescreened had a persistent positive test.
Our documentation of compliance with pre screening was high, however there remains room for improvement. Our rate of rescreening also falls below desired standards.
We intend to hold a teaching session for all members of the rheumatology department and re-audit post same.