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History of Medicine |

Tuberculosis and the Health Care Worker: A Historical Perspective

Kent A. Sepkowitz, MD
[+] Article and Author Information

From Memorial Sloan-Kettering Cancer Center and New York Hospital-Cornell Medical Center, New York, New York. Requests for Reprints: Kent Sepkowitz, MD, Infectious Disease Service, Memorial Sloan-Kettering Cancer Center, New York Hospital-Cornell Medical Center, 1275 York Avenue, Box 288, New York, NY 10021. Acknowledgment: The author thanks the staffs of the medical libraries of Memorial Sloan-Kettering Cancer Center and of Cornell Medical Center for their assistance. Grant Support: In part by National Institute of Allergy and Infectious Disease AIDS Clinical Trials Group grant 5 U01 AI27669-04.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1994;120(1):71-79. doi:10.7326/0003-4819-120-1-199401010-00012
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Many hospital outbreaks of tuberculosis have occurred in recent years in the United States, resulting in tuberculosis infection and disease among health care workers and patients.Several hospital workers have died of nosocomially acquired multidrug-resistant tuberculosis. Assuring the safety of the health care worker with respect to tuberculosis has become an urgent priority. A review of the medical literature of the past 100 years reveals that our current view of tuberculosis care as an occupational hazard emerged only in the 1950s, after a fierce and extensive debate. Many authorities had felt that care of the tuberculous patient conferred a health advantage to the care provider. This paper reviews this debate and considers steps taken decades ago, before our current environmental interventions were available to ensure the safety of the health care worker.

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Figure 1.
Tuberculosis mortality among men in 1930.[148]

Physicians and surgeons have very low risk, prompting the author to suggest the occupational hazard of caring for the tuberculous was minimal. Adapted with permission from Brahdy .

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Figure 2.
Cases of tuberculosis among employees in Los Angeles County hospitals.[161]

Decrease began in 1951 with the institution of a mandatory admission chest radiograph for all patients. Adapted with permission from Jacobson and colleagues .

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