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Study finds declining TB conversion rates
These days, some opponents of the new federal TB standard proposed by the Office of Safety and Health Administration (OSHA) are using the study known as StaffTRAK as a club to beat up the feds. That’s because the study’s preliminary conclusions show conversion rates among health care workers are down, down, down — without the help of a new federal law.
All the fuss makes it easy to forget StaffTRAK is also a useful piece of software. Developed in the ’80s in the old DOS style, it originally was designed to track TB conversion rates among health care employees.
Four years ago, the software was first shipped out to sites interested in tightening up their skin-testing protocols and eager to try a new product designed to help them do so, explains Lauren Lambert, MPA. Lambert, project manager for StaffTRAK, is a public health analyst at the Surveillance Section of the Division of TB Elimination at the Centers for Disease Control and Prevention in Atlanta.
The aim of the StaffTRAK study, she adds, was threefold: to see how well selected sites were monitoring skin-test conversions; to find out what some of the actual rates looked like; and to test a new product — namely, the StaffTRAK software — intended to make tracking those rates less of a headache.
"In lots of places, it’s all still done manually," says Lambert. "When I worked in New York City, we had everything on little note cards. At the time, they were trying to get the system computerized; but basically you’d go for your skin test, and they’d stick your card back in the file. It wasn’t the best way."
Sites get personal service as well
Enter StaffTRAK. The software comes with a formidable, three-inch-thick manual; a Y2K-compatibility diskette; and Lambert herself, whose expertise is available only to sites chosen for the study.
Overall, the software seems to have gotten a thumbs-up. "To many of the sites, this has been a real godsend," Lambert reports. "People are definitely more compliant about getting their test and, when it’s indicated, their follow-up evaluation. Plus, now all these sites can say with certainty that 100% of their workers are getting tested every year."
Among the program’s special features is a "delinquent" list, which keeps tabs on those who’ve been remiss about getting their annual screening. The list automatically fires off letters to skin-test slackers, reminding them to come in for a test or follow-up.
As for the declining conversion rates the project so famously has found, the data are still undergoing analysis, Lambert cautions. Still, preliminary results do show a substantial decline for most job categories. (The exceptions include pathologists and morgue techs.)
Sites were selected mostly on the basis of how well they responded to proposals, not according to geographic representation, she notes. At the outset, sites were checked to make sure they had isolation facilities in place, airflow properly under control, and were administering and reading skin tests by the books — preconditions that leave OSHA officials arguing that the data aren’t representative of other places in the nation.
True enough, says Yvette Davis, MD, MPH, epidemiologist with the Surveillance Section of the CDC’s Department of TB Elimination and chief analyst for the StaffTRAK data. OSHA needs to remember, she adds, that most of the data date back to the days of higher TB rates and thus don’t altogether reflect today’s lower rates. That means the StaffTRAK conversion rates, low as they are, probably are still much higher than the national average these days.
The study is headed into a second and third phase. For one thing, epidemiologists are now using it to measure conversion rates among laboratory workers. In addition, they want to use the software to try to get a handle on how much it costs a facility to implement an effective skin-testing program, says Lambert.
Sites that would like to have a crack at plugging in the software on their own can do so, Lambert adds — even though they’ll have to go it alone. "For a DOS program, people say it’s fairly user-friendly," she reports. Sites that already have data on conversions ready to download may find the task of using the software easier, she adds.
Among those who’ve taken the plunge, ordering the hefty manual and software package, are the Santa Barbara Health Care Services; the New England Medical Center Hospital; the Portland, OR, Health Division; and sites as far afield as Thailand; Lima, Peru; and Australia. Some places content themselves by getting only the four handy forms the software uses to collect the skin-test data, Lambert says.
Anyone who wants to give StaffTRAK a shot is free to do so. Requests for forms or software and manual should be written and accompanied by an explanation of what the intended use of the software will be. Contact Lauren Lambert, CDC NCHSTP, Division of TB Elimination, Mailstop E-10, 1600 Clifton Road N.E., Atlanta, GA, 30333.