A simple protocol for tuberculin skin test reading certification

Detalhes bibliográficos
Autor(a) principal: Lara de Lima Gloria
Data de Publicação: 2021
Outros Autores: Mayara Lisboa Bastos, Bráulio dos Santos Júnior, Anete Trajman
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Cadernos de Saúde Pública
Texto Completo: https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/7826
Resumo: Although tuberculosis preventive therapy is one of the cornerstones for eliminating the disease, many barriers exist in the cascade of care for latent tuberculosis infection, including the need to certify healthcare professionals for reading tuberculin skin tests (TST). This paper proposes and evaluates a simple protocol for TST reading training. Primary care workers from different backgrounds received a 2-hour theoretical course, followed by a practical course on bleb reading. Blebs were obtained by injecting saline into sausages and then in volunteers. A certified trainer then evaluated the effectiveness of this protocol by analyzing the trainees’ ability to read TST induration in clinical routine, blinded to each other’s readings. Interobserver agreement was analyzed using the Bland-Altman test. The trainees’ reading accuracy was calculated using two cut-off points - 5 and 10mm - and the effect of the number of readings was analyzed using a linear mixed model. Eleven healthcare workers read 53 saline blebs and 88 TST indurations, with high agreement for TST reading (0.07mm average bias). Sensitivity was 100% (94.6; 100.0) at 5mm cut-off and 87.3% (75.5; 94.7) at 10mm cut-off. The regression model found no effect of the number of readings [coefficient: -0.007 (-0.055; 0.040)]. A simple training protocol for reading TST with saline blebs simulations in sausages and volunteers was sufficient to achieve accurate TST induration readings, with no effect observed for the number of readings. Training with saline blebs injected into voluntary individuals is safer and easier than the traditional method.
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spelling A simple protocol for tuberculin skin test reading certificationTraining CoursesObserver VariationTuberculin TestAlthough tuberculosis preventive therapy is one of the cornerstones for eliminating the disease, many barriers exist in the cascade of care for latent tuberculosis infection, including the need to certify healthcare professionals for reading tuberculin skin tests (TST). This paper proposes and evaluates a simple protocol for TST reading training. Primary care workers from different backgrounds received a 2-hour theoretical course, followed by a practical course on bleb reading. Blebs were obtained by injecting saline into sausages and then in volunteers. A certified trainer then evaluated the effectiveness of this protocol by analyzing the trainees’ ability to read TST induration in clinical routine, blinded to each other’s readings. Interobserver agreement was analyzed using the Bland-Altman test. The trainees’ reading accuracy was calculated using two cut-off points - 5 and 10mm - and the effect of the number of readings was analyzed using a linear mixed model. Eleven healthcare workers read 53 saline blebs and 88 TST indurations, with high agreement for TST reading (0.07mm average bias). Sensitivity was 100% (94.6; 100.0) at 5mm cut-off and 87.3% (75.5; 94.7) at 10mm cut-off. The regression model found no effect of the number of readings [coefficient: -0.007 (-0.055; 0.040)]. A simple training protocol for reading TST with saline blebs simulations in sausages and volunteers was sufficient to achieve accurate TST induration readings, with no effect observed for the number of readings. Training with saline blebs injected into voluntary individuals is safer and easier than the traditional method.La terapia preventiva de la tuberculosis es una de las piedras angulares para la erradicación de la tuberculosis. No obstante, existen muchas barreras en la cascada de cuidado de una infección latente de tuberculosis, incluyendo la necesidad de certificación, en el caso de los profesionales de atención en salud, para la lectura de la prueba cutánea de tuberculina (TST). Aquí proponemos y evaluamos un protocolo simple para el entrenamiento en la lectura de TST. Trabajadores de salud de atención primaria de diferentes contextos recibieron un curso de 2 horas teórico, seguido de una práctica en la lectura de la ampolla. Las ampollas se obtienen inyectado una solución salina en salchichas y luego en voluntarios. Posteriormente, la eficacia de este protocolo fue evaluada mediante un formador certificado a través de la habilidad del personal en formación para la lectura de induración del TST en la rutina clínica, con lecturas cegadas entre ellos. Se analizó la concordancia entre los observadores usando el test Bland-Altman. La precisión de la lectura por parte del personal en formación se calculó usando dos puntos de corte: 5 y 10mm. El efecto del número de lecturas fue analizado usando un modelo lineal mixto. Once trabajadores de salud leyeron 53 soluciones salinas en ampollas y 88 induraciones TST. La concordancia en la lectura del TST fue alta (0,07mm promedio de sesgo). La sensibilidad fue de un 100% (94,6; 100,0) usando los 5mm de corte y 87,3% (75,5; 94,7) usando los 10mm de corte. En el modelo de regresión, no hubo efecto del número de lecturas [coeficiente: -0,007 (-0,055; 0,040)]. Un simple protocolo de entrenamiento para la lectura TST con simulaciones, usando solución salina en ampollas en salchichas y voluntarios fue suficiente para alcanzar lecturas precisas de induración TST, sin efectos observados por el número de lecturas. El entrenamiento con ampollas salinas en personas voluntarias es más seguro y más fácil que el entrenamiento tradicional.A terapia preventiva da tuberculose é uma das bases para a eliminação da tuberculose. Entretanto, existem muitas barreiras na cascata de cuidados da infecção latente de tuberculose, incluindo a necessidade de certificação dos profissionais de saúde para a leitura da prova tuberculínica (PPD). Aqui, propomos e avaliamos um protocolo simples para capacitação na leitura do PPD. Profissionais na atenção primária com diferentes formações receberam um curso teórico de duas horas, seguido por um curso prático sobre a leitura da enduração. Nas sessões práticas, as pápulas foram obtidas pela injeção de solução salina em salsichas, e depois em voluntários. Depois, a eficácia do protocolo foi avaliada por um instrutor credenciado, com base na capacidade do aluno de ler a enduração do PPD na rotina clínica (em formato duplo-cego em relação às respectivas leituras). A concordância inter-observador foi analisada com o teste de Bland-Altman. A acurácia das leituras dos alunos foi calculada com dois pontos de corte: 5 e 10mm. O efeito do número de leituras foi analisado com um modelo linear misto. Onze profissionais de saúde leram 53 pápulas de solução salina e 88 endurações de PPD. A concordância na leitura dos PPDs foi alta (média de 0,07mm de viés). A sensibilidade foi 100% (94,6; 100,0) com o ponto de corte de 5mm e 87,3% (75,5; 94,7) com o ponto de corte de 10mm. No modelo de regressão, não houve efeito do número de leituras [coeficiente: -0,007 (-0,055; 0,040)]. Um protocolo simples de treinamento em leitura da prova tuberculínica com simulações usando pápulas criadas com solução salina em salsichas e em voluntários foi suficiente para alcançar leituras acuradas da enduração da prova, sem efeito observado pelo número de leituras. O treinamento com pápulas criadas com solução salina em voluntários é mais seguro e mais fácil, comparado com o treinamento tradicional.Reports in Public HealthCadernos de Saúde Pública2021-08-30info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlapplication/pdfhttps://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/7826Reports in Public Health; Vol. 37 No. 8 (2021): AugustCadernos de Saúde Pública; v. 37 n. 8 (2021): Agosto1678-44640102-311Xreponame:Cadernos de Saúde Públicainstname:Fundação Oswaldo Cruz (FIOCRUZ)instacron:FIOCRUZenghttps://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/7826/17506https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/7826/17507Lara de Lima GloriaMayara Lisboa BastosBráulio dos Santos JúniorAnete Trajmaninfo:eu-repo/semantics/openAccess2024-03-06T15:30:12Zoai:ojs.teste-cadernos.ensp.fiocruz.br:article/7826Revistahttps://cadernos.ensp.fiocruz.br/ojs/index.php/csphttps://cadernos.ensp.fiocruz.br/ojs/index.php/csp/oaicadernos@ensp.fiocruz.br||cadernos@ensp.fiocruz.br1678-44640102-311Xopendoar:2024-03-06T13:08:59.518230Cadernos de Saúde Pública - Fundação Oswaldo Cruz (FIOCRUZ)true
dc.title.none.fl_str_mv A simple protocol for tuberculin skin test reading certification
title A simple protocol for tuberculin skin test reading certification
spellingShingle A simple protocol for tuberculin skin test reading certification
Lara de Lima Gloria
Training Courses
Observer Variation
Tuberculin Test
title_short A simple protocol for tuberculin skin test reading certification
title_full A simple protocol for tuberculin skin test reading certification
title_fullStr A simple protocol for tuberculin skin test reading certification
title_full_unstemmed A simple protocol for tuberculin skin test reading certification
title_sort A simple protocol for tuberculin skin test reading certification
author Lara de Lima Gloria
author_facet Lara de Lima Gloria
Mayara Lisboa Bastos
Bráulio dos Santos Júnior
Anete Trajman
author_role author
author2 Mayara Lisboa Bastos
Bráulio dos Santos Júnior
Anete Trajman
author2_role author
author
author
dc.contributor.author.fl_str_mv Lara de Lima Gloria
Mayara Lisboa Bastos
Bráulio dos Santos Júnior
Anete Trajman
dc.subject.por.fl_str_mv Training Courses
Observer Variation
Tuberculin Test
topic Training Courses
Observer Variation
Tuberculin Test
description Although tuberculosis preventive therapy is one of the cornerstones for eliminating the disease, many barriers exist in the cascade of care for latent tuberculosis infection, including the need to certify healthcare professionals for reading tuberculin skin tests (TST). This paper proposes and evaluates a simple protocol for TST reading training. Primary care workers from different backgrounds received a 2-hour theoretical course, followed by a practical course on bleb reading. Blebs were obtained by injecting saline into sausages and then in volunteers. A certified trainer then evaluated the effectiveness of this protocol by analyzing the trainees’ ability to read TST induration in clinical routine, blinded to each other’s readings. Interobserver agreement was analyzed using the Bland-Altman test. The trainees’ reading accuracy was calculated using two cut-off points - 5 and 10mm - and the effect of the number of readings was analyzed using a linear mixed model. Eleven healthcare workers read 53 saline blebs and 88 TST indurations, with high agreement for TST reading (0.07mm average bias). Sensitivity was 100% (94.6; 100.0) at 5mm cut-off and 87.3% (75.5; 94.7) at 10mm cut-off. The regression model found no effect of the number of readings [coefficient: -0.007 (-0.055; 0.040)]. A simple training protocol for reading TST with saline blebs simulations in sausages and volunteers was sufficient to achieve accurate TST induration readings, with no effect observed for the number of readings. Training with saline blebs injected into voluntary individuals is safer and easier than the traditional method.
publishDate 2021
dc.date.none.fl_str_mv 2021-08-30
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
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dc.identifier.uri.fl_str_mv https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/7826
url https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/7826
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/7826/17506
https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/7826/17507
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv text/html
application/pdf
dc.publisher.none.fl_str_mv Reports in Public Health
Cadernos de Saúde Pública
publisher.none.fl_str_mv Reports in Public Health
Cadernos de Saúde Pública
dc.source.none.fl_str_mv Reports in Public Health; Vol. 37 No. 8 (2021): August
Cadernos de Saúde Pública; v. 37 n. 8 (2021): Agosto
1678-4464
0102-311X
reponame:Cadernos de Saúde Pública
instname:Fundação Oswaldo Cruz (FIOCRUZ)
instacron:FIOCRUZ
instname_str Fundação Oswaldo Cruz (FIOCRUZ)
instacron_str FIOCRUZ
institution FIOCRUZ
reponame_str Cadernos de Saúde Pública
collection Cadernos de Saúde Pública
repository.name.fl_str_mv Cadernos de Saúde Pública - Fundação Oswaldo Cruz (FIOCRUZ)
repository.mail.fl_str_mv cadernos@ensp.fiocruz.br||cadernos@ensp.fiocruz.br
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