The Harper-Hutzel Experience

Harper University Hospital and Hutzel Women’s Hospital are two of the eight hospitals in the Detroit Medical Center in Michigan. These hospitals employ more than 2900 employees, with an additional 700 physicians having privileges. Rated as medium-risk organizations according to the CDC TB guidelines, both hospitals had been using the TST for annual screening. Recently, the Occupational Health Services Department (OHS), under the direction of Jim Russell, Executive Director of Detroit Medical Center Occupational Health Services, switched to using the T-SPOT.TB test for its annual screening program.

To implement this hospital change required the assistance of Christine Bowen, MSN, RN, CCRN, Vice President Patient Care Services; Kim Ceccanese, MSN, RN, Director of Regulatory Compliance; Silvia  Zoma,  the  Manager of PR and Marketing; Emmanuel Lansanah, BSN, RN, a Nurse Manager at Harper University and Hutzel Women’s Hospitals; and several other members of a Planning Committee, including Nichelle Goode. They describe their experience with converting to and using the T-SPOT.TB test for their annual screening program.

Christine M. Bowen, MSN, RN, CCRN (Vice President, Patient Care Services): As Vice President of Patient Care Services of Harper-Hutzel Hospitals, I take the health and wellness of our employees seriously. While the tuberculin skin test has certainly served its purpose, it had its limitations in that follow-up screening was needed for each employee and the test was impacted by BCG exposure. Now we use the T-SPOT.TB test, and it has significantly improved employee compliance with testing and plays an important role in maintaining the health of our patients, employees, and the community we proudly serve.

Jim Russell (Executive Director): Because Harper University and Hutzel Women’s Hospitals are classified as medium-risk hospitals for TB, we screen our employees annually. Before adopting the use of the T-SPOT.TB test, we primarily used the TST, and the two-step method for our new-hire employees. The logistics of using this method required offering TB screening from the centralized occupational health location, which was primarily used for injury walk-in, follow-up, and new-hire physical visits.  In  addition, we had a full-time rover who provided TB assessments in each department, so we could test our employees within  their  departments   to   reduce   their   time away from providing patient care. In order to improve the compliance of our annual screening program, we provided greater  program  accessibility to  employees  by  developing  unit-based  TB  testers and readers. Those departments without the  TB testers  and  readers  would  utilize  the   services   of the OHS rover.

Due to the labor involved in managing the screening of all of our employees, we first had a revolving cycle of screening, so different departments were screening in different months. We did this throughout the entireyear. Our compliance during that time was between 85% and 90%. We were always chasing 6% to 9% of the employees who were noncompliant during the screening times.

For our new hires, we did two-step testing that required up to four visits to occupational health. Having to come back within the 48 to 72 hours after each test was placed was just inconvenient for these new hires and it also created additional walk-in traffic in occupational health. When a TST result is positive, our protocol requires that the result be reevaluated by one other TB tester/reader. There has to be an agreement between two: this is a positive result with induration on palpating, and then the measurement of millimeters of induration is decided. Reading TSTs can be subjective. What one individual may consider induration may not palpate as induration to another, so there is reader variability that is inherent with the TST. While we ensure our tester/readers are properly trained, we can’t eliminate the subjectivity of this test.

About 2 years ago we transitioned all departments from the 12-month testing calendar to a single testing month. Our Planning Committee selected the month of October to coincide with our annual flu vaccination administration plan. We used the combined annual TB screening and flu vaccination administration process as a drill of our Mass Antidote-Dispensing Plan, a component of our Emergency Preparedness Plan.

This year, instead of using TSTs, we used the T-SPOT®.TB test and reduced our testing time to 9 days. We also paired our TB screening clinic with our influenza vaccination clinic. We developed efficient and coordinated communication and marketing plans to inform our employees and staff of the change in test type, the testing location, and the available testing times. We ran our screening clinic Monday through Saturday from 6 am to 4:30 pm, and also 9 pm to midnight Monday through Friday of that same week. Then, about 10 days later we opened the clinic again for three makeup days from 6 am to 4:30 pm for anyone who did not make it to our primary screening clinic.

Oxford Diagnostic Laboratories® assisted with the planning of the TB screening clinic, helping us determine how best to test everyone in 9 days, and to create a new process for conducting the phlebotomy for the T-SPOT.TB testing.

On our  first  day  of  screening,  we  were  caught  by a morning surge that we didn’t  foresee,  but  with the help of additional phlebotomists and the redeployment of our own staff with dual skills, we were able to quickly accommodate the needs for our clinic. Employing the concepts of Emergency Preparedness, our Mass Antidote-Dispensing Model flexed in a really responsive fashion and met the need rapidly. After that initial surge, it was smooth sailing. We were able to screen about 3500 people during those 9 days.

Not only has our compliance rate improved, but also we in OHS have already realized the time saved as we have moved on to our other vaccination programs within the Detroit Medical Center for our 15,000 employees. We no longer task our roving tester/reader to the Harper-Hutzel sites, so individuals are back to primarily caring for patients, which is a great benefit. We were able to provide our TB screening efficiently and get our employees back to work quickly. Having a test that allows us to differentiate between individuals who were TST positive due to a history of BCG vaccination is a clinical advantage to us, since we have many employees who had received the BCG vaccine.

During our prior TB screening and flu vaccination administration event, the hospital pharmacy contributed staff who were responsible for preparing each TST dose. Using the T-SPOT®.TB test, this process step was eliminated.

Kim Ceccanese (Director of Regulatory Compliance): About 2 years ago, our Compliance Steering Committee wanted to work on improving our compliance reporting, so we moved from our model of screening employees throughout the year to a single testing month model. Since our flu clinic occurred in October, we decided to combine the two. We designated a screening site so that we could keep all of the paperwork together, and so our employees knew where to come to get their TST read. We had the employees come to the clinic to have their TSTs placed and then returned within 48 to 72 hours to have them read. Using the single screening month improved our reporting capabilities and tracking employees who needed to get screened, but we had to chase down people to get their readings done. We still had employees who didn’t come back within the necessary time and would have to have another TST placed and read.

For our annual TB screening using the T-SPOT.TB test, we were fortunate enough to be able to use a closed nursing unit. I was in charge of staffing for the nurses and other nonclinical people for all the different stations that we had during the screening week. We had an intake area designated for the employees to complete their paperwork, and then they were directed to one of the two flu rooms with three vaccinators in each room. Next, the employees moved to one of the TB screening rooms, which is where the phlebotomy took place for the T-SPOT.TB test. We initially had two rooms set up with a total of eight stations but expanded the number of stations on the first day because we had such an enormous response. We ended up having twelve stations the first day. Finally, we had eight checkout stations where the employees had their paperwork processed.

Nichelle Goode (Administrative Secretary): I helped with our annual screening using the T-SPOT.TB test. We had two checkout rooms with four computers each and various people working different shifts. This setup helped us process everyone’s paperwork so our employees could get back to work quickly.

Silvia Zoma (PR and Marketing): I managed the communications with the employees and physicians, and getting the word out about the new TB screening program using the T-SPOT®.TB test. I made sure everyone knew when the screening would occur. From my perspective, it was a smooth process; the employees came and were really impressed by the flow of everything. There was really no waiting for the employees. Employees have also responded positively to the test. Surveys were collected from the employees as they exited the screening area. Of the approximately 1800 employees who responded, 75% agreed that they are very comfortable having a blood test for their annual TB test, and 90% of employees agreed that it was very important that their employer provide the most accurate TB screening test available.

Emmanuel Lansanah (Nurse Manager): Before using the T-SPOT.TB test, we spent a lot of time on our TB surveillance throughout the year. Now that we are using T-SPOT.TB testing and doing it during a single month of the year, we know it is done. We don’t have to pull our nurses from the bedside and make them go get tested. We can concentrate on patient care.

To learn more about the T-SPOT.TB test, fill out the form to the right or call 1-877-20-TSPOT today and you can be testing tomorrow.

For a printer friendly version of this case study, click here.