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Preventing the Nosocomial Transmission of Tuberculosis

Henry M. Blumberg, MD; Dan L. Watkins, PA-C; Jeffrey D. Berschling, MPH; Alexis Antle, BA; Patricia Moore, RN; Nancy White, RN; Mary Hunter, MD; Barbara Green, RN; Susan M. Ray, MD; and John E. McGowan, MD
[+] Article, Author, and Disclosure Information

From Emory University School of Medicine and Grady Memorial Hospital, Atlanta, Georgia. Requests for Reprints: Henry M. Blumberg, MD, Division of Infectious Diseases, Emory University School of Medicine, 69 Butler Street SE, Atlanta, GA 30303. Grant Support: In part by National Institutes of Health grant K07 HL03078-01, Georgia Department of Human Resources contract 427-93-41861, and the Robert Wood Johnson Foundation. Acknowledgments: The authors thank John Decker of the National Institute of Occupational Safety and Health for doing the tracer gas study and J. William Eley, MD, for assistance with statistical analyses.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1995;122(9):658-663. doi:10.7326/0003-4819-122-9-199505010-00003
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Objective: To study the efficacy of expanded tuberculosis infection control measures consisting primarily of administrative controls.

Design: Descriptive case series.

Setting: University-affiliated, inner-city hospital.

Interventions: Introduction of expanded tuberculosis infection control measures (including an expanded respiratory isolation policy).

Measurements: The number of tuberculosis exposure episodes and skin test conversion rates of health care workers were measured before and after implementation of expanded infection control measures. Tuberculosis exposure episodes (the number of patients who were not placed in respiratory isolation at admission but who subsequently had a diagnosis of acid-fast bacilli smear-positive pulmonary tuberculosis during that admission or within 2 weeks of discharge) were compared for two time periods: the 8 months before and the 28 months after implementation of infection control measures. Tuberculin skin test conversion rates among health care workers were evaluated during a 2.5-year period.

Results: After expanded infection control measures were implemented, the number of tuberculosis exposure episodes decreased from 4.4 per month (35 episodes among 103 patient admissions for potentially infectious tuberculosis over 8 months) to 0.6 per month (18 episodes among 358 patient admissions for smear-positive pulmonary tuberculosis over 28 months) (odds ratio, 9.72; 95% CI, 4.99 to 19.25 [P < 0.001]). The cumulative number of days per month that potentially infectious patients with tuberculosis were not in isolation decreased from 35.4 to 3.3 (P < 0.001). A concomitant decrease in tuberculin skin test conversion rates in health care workers was seen; 6-month tuberculin skin test conversion rates decreased steadily from 3.3% (118 conversions in 3579 health care workers; 1/92 to 6/92), 1.7%, 1.4%, 0.6%, to 0.4% (23 conversions in 5153 workers [1/94 to 6/94]) (P < 0.001).

Conclusions: Infection control measures effectively prevented nosocomial transmission of tuberculosis to health care workers. Administrative controls appear to be the most important component of a tuberculosis infection control program and should be the first focus of such a program, especially at public hospitals, where resources are most likely to be limited.


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Figure 1.
Number of admissions of patients with tuberculosis (TB) to Grady Memorial Hospital.

The number of admissions of patients with tuberculosis and the number of admissions in which patients with tuberculosis had respiratory (sputum or bronchoalveolar lavage fluid) specimens that were acid-fast bacilli (AFB) smear-positive and culture-positive is shown in 6-month intervals during the 3-year study period.

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Grahic Jump Location
Figure 2.
Number of tuberculosis exposure episodes per month.

The arrow indicates when the new expanded respiratory isolation policy was introduced.

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Figure 3.
Six-month tuberculin skin test (TST) conversion rates for health care workers at Grady Memorial Hospital.

The number of health care workers with a positive test result divided by the total number of health care workers tested during that time is shown above each bar.

Grahic Jump Location




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