Chest
Volume 117, Issue 2, February 2000, Pages 380-384
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Clinical Investigations
Nosocomial Tuberculosis Prevention Measures Among Two Groups of US Hospitals, 1992 to 1996

https://doi.org/10.1378/chest.117.2.380Get rights and content

Objective

To compare trends in nosocomial tuberculosis (TB) prevention measures and health-care worker (HCW) tuberculin skin test (TST) conversion of hospitals with HIV-related Pneumocystis carinii pneumonia (PCP) patients and other US hospitals from 1992 through 1996.

Design and setting

Surveys in 1992 and 1996 of 38 hospitals with PCP patients in four high-HIV-incidence cities and 136 other US hospitals from the American Hospital Association membership list.

Participants

Twenty-seven hospitals with PCP patients and 103 other US hospitals.

Results

In 1992, 63% of PCP hospitals and other US hospitals had rooms meeting Centers for Disease Control and Prevention (CDC) criteria (ie, negative air pressure, six or more air exchanges per hour, and air directly vented to the outside) for acid-fast bacilli isolation; in 1996, almost 100% had such isolation rooms. Similarly, in 1992, nonfitted surgical masks were used by HCWs at 60% of PCP hospitals and 68% at other US hospitals, while N95 respirators were used at 90% of PCP hospitals and 83% of other US hospitals in 1996. There was a significant decreasing trend in TST conversion rates among HCWs at both PCP and other US hospitals; however, this trend varied among all hospitals. HCWs at PCP hospitals had a higher risk of TST conversion than those at other US hospitals (relative risk, 1.71; p < 0.0001).

Conclusion

From 1992 through 1996, PCP and other US hospitals have made similar improvements in their nosocomial TB prevention measures and decreased their HCW TST conversion rate. These data show that most hospitals are compliant with CDC TB guidelines even before the enactment of an Occupational Safety and Health Administration TB standard.

Section snippets

Materials and Methods

In April 1992, we mailed questionnaires to the department of infection control of a 50% random sample (n = 38) of 76 hospitals that specialized in providing care to HIV patients in four high-HIV-incidence cities (New York, Chicago, Los Angeles, and Miami). These 76 hospitals had been providing care to patients with HIV-related PCP since 1987 and were randomly selected to participate in a separate study to investigate variations in quality of care for hospitalized patients with HIV-related PCP.12

Hospital Characteristics

The response rate was 71% for PCP hospitals (27/38) and 76% for the other US hospitals (103/136). Of the 130 respondents, 28 (22%) had≤ 199 adult acute-care beds, 53 (41%) had 200 to 399 beds, and 42 (32%) had ≥ 400 beds; 43 were university-affiliated (33%), 30 were community teaching (23%), and 48 were community nonteaching hospitals (37%).

TB Admissions

The number of hospitals to which TB patients were admitted remained stable from 1989 to 1996. While the median number of annual TB patient admissions ranged

Discussion

Nosocomial transmission of MTB remains a great threat to public health. The 1997 publication of the proposed TB standard by OSHA has heightened this awareness among HCWs, especially those at hospitals with TB patient admissions. Various ways to prevent nosocomial transmission of and occupational exposure to MTB have been published8, 9, 11 since the resurgence of TB in 1985. The efficacy of these guideline recommendations have been documented in several studies.13, 14, 15 However, the reports of

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