Evaluating an Education Program to Reduce Indeterminate QuantiFERON Gold In-Tube Results

Background: The QuantiFERON Gold In-Tube (QFT-G) assay is used to identify individuals with tuberculosis infection and gives quantitative and qualitative results including positive, negative, or indeterminate results (that cannot be interpreted clinically). Several factors, including immunosuppression and preanalytical factors, have been suggested to be significantly associated with indeterminate QFT-G results. An online education program was designed and implemented to reduce the rate of indeterminate QFT-G test results at Houston Methodist Hospital (HMH).

Methods: Data from patients' electronic medical records having indeterminate QFT-G results between 01/2015 and 05/2016 at HMH in Houston, TX, were administratively extracted for (1) medical unit where QFT-G phlebotomy was performed, (2) demographics, and (3) ICD-9/10 diagnosis codes. Unit nurses identified with high proportions of indeterminate QFT-G results were emailed a link to an online pretest educational program with a QFT-G blood collection and handling presentation, and a posttest assessment.

Results: Of the 332 nurses emailed, 94 (28.4%) voluntarily completed both tests within the 6-month time allotted. The nurses that completed the education program had a significantly higher posteducation test score than on the pretest (70.2% versus 55.3%, p<0.001, effect size=0.82). Improved posttest score was seen in 67.0% of participants. No reduction in the proportion of indeterminate test results was seen overall at HMH in the 6 months after education.

Conclusions: A targeted education program was able to successfully increase nurses' knowledge of blood collection and handling procedures for the QFT-G test, but no association was found between the improvement of posttest score and indeterminate QFT-G test results.