Latent Tuberculosis Infection Testing Practices in Long-Term Care Facilities, Boston, Massachusetts - American Geriatric Society

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.

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