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TB (tuberculosis) skin testing for public safety

After years of decline TB is back and on the increase. Pima County has had the highest rates in the state.

Skin test:

10 mm or more of induration (swelling) is positive for health care and public safety workers with normal immunity. Redness alone doesn’t count.  If positive the doctor/nurse practitioner will decide:

  1. Need for initial chest x-ray (may have just had one elsewhere so no need to repeat).

  2. Radiologist may request extra x-ray views if any concerns on initial x-ray.

If your Chest x-ray is negative you do not have active TB

  1. You can’t give it to anyone at home or work

  2. Because ten percent of people with a positive skin test and NEGATIVE chest x-rays will develop active TB later in life there’s a medication to prevent that.

TB prophylaxis (medication):

  1. Risks of medication to the liver increase with age, especially after age 35.

  2. Usual medication is INH (isoniazid) 300 mg a day for 9 months

  1. If you are placed on medication have your liver functions (blood test) tested periodically.

Where to go for help:

  1. See your personal physician.

  2. Pima County Health Department – Note, there is a charge.

  3. If positive skin test is from an exposure, then see (1) or (2) or your companies/organizations occupational medical clinic.

Who pays:

  1. Your agency covers cost of TB skin tests.

  2. If you need a chest x-ray or medication you would have to prove to your worker’s compensation carrier that you became ill at work for it to be considered an industrial case.

  3. Some agencies will pay cost of the above.

  4. Most do not and advise you to seek care at your personal physician

Symptoms of TB:

  1. Chronic cough with phlegm, often bloody.

  2. Night sweats, fever, weight loss.

Further information:  CDC.org., Pima County Health Department, Tuberculosis.

Bed Bugs at a Glance

A downloadable PDF: Bed_Bugs_At_A_Glance_WellAmerica

Bed bugs are small, oval non-flying insects that feed by sucking blood from humans or animals. Bed bugs can live in any area of the home and can reside in tiny cracks in furniture as well as on textiles and upholstered furniture. They tend to be most common in areas where people sleep and generally concentrate in beds, including mattresses, box springs, and bed frames.

Bed bugs are most active at night and bite any exposed areas of skin while an individual is sleeping. The face, neck, hands, and arms are common sites for bed bug bites.  A bed bug bite is painless and is not noticed. Small, flat, or raised bumps on the skin are the most common sign: redness, swelling, and itching commonly occur.

Typically, no treatment is required for bed bug bites. If itching is severe, steroid creams or oral antihistamines may be used for symptom relief. Fecal stains, egg cases, and exuviae (shed skins) of bed bugs in crevices and cracks on or near beds are suggestive that bed bugs may be present, but only observing the bugs themselves can confirm an active infestation.

A professional pest-control company may be required to help identify and remove bed bugs from the home or workplace.

Prevention of bed bug bites?

Avoidance of infested areas is the method for prevention of bed bug bites. Recognition of bed bug infestation and proper treatment of affected rooms (usually with the help of a pest-control specialist) is the best way to prevent bed bugs in the home. Those concerned about the potential for bed bugs bites in hotels, dorms, or other common sleeping areas (fire house, etc.) should examine beds and mattresses for signs of a bed bug infestation. Sealing your mattress in a bed bug prevention casing can be beneficial.

Getting Rid of Bed Bugs

Getting rid of bed bugs is not an easy process, and most cases of bed bug infestation will require treatment by a pest-control expert. A variety of low-odor sprays, dusts, and aerosol insecticides can be used to eradicate bed bugs. These must be applied to all areas where the bugs are observed as well as spaces where they may crawl or hide.  The pest-control company can help you determine if the mattress can be disinfected or must be discarded. Since beds cannot readily be treated with insecticides, it’s often necessary to discard infested mattresses and beds.

The pest-control expert may recommend certain forms of deep-cleaning such as scrubbing infested surfaces with a stiff brush to remove eggs, dismantling bed frames and furniture, filling cracks in floors, walls, and moldings, encasing mattresses within special bags, or using a powerful vacuum on cracks and crevices.

How do I get rid of bed bugs?

Eradication of bedbugs frequently requires a combination of pesticide and non-pesticide approaches. Pesticides that have historically been found to be effective include: pyrethroidsdichlorvos and malathion. Resistance to pesticides has increased significantly over time and there are concerns of negative health effects from their use. Mechanical approaches such as vacuuming up the insects and heat treating or wrapping mattresses have been recommended.

The carbamate insecticide propoxur is highly toxic to bedbugs, but the Environmental Protection Agency (EPA) has been reluctant to approve such an indoor use because of its potential toxicity to children after chronic exposure.


University Medical Center Bug-O-Gram, 8/2011

Greenberg, L., and J. H. Klotz. “Pest Notes: Bed Bugs.” Oakland: Univ. Calif. Nat. Agric. Res. Publ. 7454. Sept. 2002.

Harvard School of Public Health

Potter, Michael F. “Bed Bugs.” University of Kentucky College of Agriculture. Aug. 2008.

Thomas, I., G.G. Kihiczak, and R.A. Schwartz. “Bedbug Bites: A Review.” Int J Dermatol 43 (2004): 430.