Screening health care workers with interferon-γ release assay versus tuberculin skin test: impact on costs and adherence to testing (the SWITCH study).

OBJECTIVE: To determine the price point at which an interferon-γ release assay (IGRA) is less costly than a tuberculin skin test (TST) for health care employee tuberculosis screening. METHODS: A multidecision tree-based cost model incorporating inputs gathered from time-motion studies and parallel testing by IGRA and TST was conducted in a subset of our employees. RESULTS: Administering a TST testing program costs $73.20 per person screened, $90.80 per new hire, and $63.42 per annual screen. Use of an IGRA for employee health testing is cost saving at an IGRA test cost of $54.83 or less per test and resulted in higher completion rates because of the elimination of the need for a second visit to interpret the TST. CONCLUSIONS: Using an IGRA for employee health screening can be an institutional cost saving and results in higher compliance rates.

Description of an influenza vaccination campaign and use of a randomized survey to determine participation rates.

OBJECTIVES: To describe the procedures used during an influenza immunization program and the use of a randomized survey to quantify the vaccination rate among healthcare workers with and without patient contact. DESIGN: Influenza immunization vaccination program and a randomized survey. SETTING: Johns Hopkins University and Health System. METHODS: The 2008/2009 Johns Hopkins Influenza Immunization Program was administered to 40,000 employees, including 10,763 healthcare workers. A 10% randomized sample (1,084) of individuals were interviewed to evaluate the vaccination rate among healthcare workers with direct patient contact. RESULTS: Between September 23, 2008, and April 30, 2009, a total of 16,079 vaccinations were administered. Ninety-four percent (94.5%) of persons who were vaccinated received the vaccine in the first 7 weeks of the campaign. The randomized survey demonstrated an overall vaccination rate of 71.3% (95% confidence interval, 68.6%-74.0%) and a vaccination rate for employees with direct patient contact of 82.8% (95% confidence interval, 80.1%-85.5%). The main reason (25.3%) for declining the program vaccine was because the employee had received documented vaccination elsewhere. CONCLUSIONS: The methods used to increase participation in the recent immunization program were successful, and a randomized survey to assess participation was found to be an efficient means of evaluating the workforce's level of potential immunity to the influenza virus.