Latent Tuberculosis Infection Testing Practices in Long‐Term Care Facilities, Boston, Massachusetts

• Published in: Journal of the American Geriatrics Society (JAGS) Vol. 65; no. 6; pp. 1145 - 1151
• Main Authors: Reddy, Divya, Walker, Jacob, White, Laura F., Brandeis, Gary H., Russell, Matthew L., Horsburgh, Charles R., Hochberg, Natasha S.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.06.2017
• Subjects: Aged; Boston - epidemiology; Diagnostic tests; Disease Outbreaks - prevention & control; Drug use; elderly; Ethnic Groups - statistics & numerical data; Female; Geriatrics; Hospitalization; Humans; latent tuberculosis; Latent Tuberculosis - diagnosis; Latent Tuberculosis - epidemiology; Latent Tuberculosis - ethnology; Long term health care; Long-Term Care - statistics & numerical data; long‐term care facilities; Male; Nursing Homes; Outbreaks; Prevalence; Retrospective Studies; Reviews; testing; Tuberculin Test - statistics & numerical data; Tuberculosis; latent tuberculosis; long-term care facilities; elderly; nursing homes; testing
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/jgs.14696

Objectives To describe latent tuberculosis infection (LTBI) testing practices in long‐term care facilities (LTCFs). Design Retrospective cohort study. Setting Three Boston‐area LTCFs. Participants Residents admitted between January 1 and December 31, 2011. Measurements Resident demographic characteristics, comorbidities, LTCF stay, and LTBI testing and treatment. Results Data for 291 LTCF residents admitted in 2011 were reviewed. Of the 257 without a history of LTBI and with documentation of testing, 162 (63%) were tested; 114 of 186 (61%) with a stay less than 90 days and 48 of 71 (68%) with a stay of 90 days or longer were tested. Of 196 residents with data on prior LTBI testing, 39 (19.9%) had LTBI; 12 of these (30.8%) were diagnosed at the LTCF. Hispanic participants were more likely than black participants to undergo LTBI testing (adjusted odds ratio (aOR) = 2.4, P = .003). Having a length of stay of less than 90 days (aOR = 0.7, P < .001) and history of illicit drug use (aOR = 0.7, P < .001) were associated with lower odds of LTBI testing. Conclusion One‐fifth of LTCF residents had LTBI, but testing was not always performed. The high prevalence of LTBI in older adults combined with the risk of an outbreak if a case of tuberculosis occurs in a LTCF make LTBI testing and treatment an important prevention opportunity. The importance of LTBI testing in LTCFs needs to be reinforced.