0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

Hospital Ventilation and Risk for Tuberculous Infection in Canadian Health Care Workers

Dick Menzies, MD, MSc; Anne Fanning, MD; Lilian Yuan, MD; J. Mark FitzGerald, MD, the Canadian Collaborative Group in Nosocomial Transmission of TB*
[+] Article and Author Information

Copyright ©2004 by the American College of Physicians


Ann Intern Med. 2000;133(10):779-789. doi:10.7326/0003-4819-133-10-200011210-00010
Text Size: A A A

Background: The risk for and determinants of transmission of tuberculosis in hospitals caring for moderate numbers of patients with tuberculosis remain uncertain.

Objective: To study the association of tuberculin conversion among health care workers with ventilation of patient care areas.

Design: Cross-sectional observational survey.

Setting: 17 acute-care community or university hospitals.

Participants: All personnel who worked at least 2 days per week in the respiratory and physiotherapy departments or in selected nursing units.

Measurements: Participating workers underwent tuberculin skin testing and completed self-administered questionnaires. Previous tuberculin tests and bacille Calmette-Guérin vaccinations were verified. Records of patients with tuberculosis who were hospitalized in the 3 years preceding the study were reviewed. Air exchanges per hour in patient care areas were measured by using a tracer gas technique. Multivariate proportional hazards regression was used to estimate the effect of occupational factors on documented tuberculin conversion, after adjustment for nonoccupa- tional factors, among participants with at least one previous negative result on tuberculin skin testing.

Results: Tuberculin conversion was associated with ventilation of general or nonisolation patient rooms of less than 2 air exchanges per hour (adjusted hazard ratio, 3.4 [95% CI, 2.1 to 5.8]); with work in moderate- to high-risk hospitals (adjusted hazard ratio, 2.2 [CI, 1.3 to 3.5]); and with work in the nursing (adjusted hazard ratio, 4.3 [CI, 2.7 to 6.9]), respiratory therapy (adjusted hazard ratio, 6.1 [CI, 3.1 to 12.0]), and physiotherapy (adjusted hazard ratio, 3.3 [CI, 1.5 to 7.2]) departments or housekeeping (adjusted hazard ratio, 4.2 [CI, 2.3 to 7.6]). Conversion was not associated with inadequate ventilation of respiratory isolation rooms (adjusted hazard ratio, 1.0 [CI, 0.8 to 1.3]).

Conclusion: Tuberculin conversion among health care workers was strongly associated with inadequate ventilation in general patient rooms and with type and duration of work, but not with ventilation of respiratory isolation rooms.

*For members of the Canadian Collaborative Group in Nosocomial Transmission of TB, see Appendix.

Figures

Grahic Jump Location
Figure 1.
Kaplan–Meier analysis of time from hiring to tuberculin conversion among all participants, stratified by level of air exchange in nonisolation rooms.ACPH

The solid line represents clinical personnel at increased-risk hospitals with fewer than two air exchanges per hour ( ), the dotted line represents clinical personnel at increased-risk hospitals with two or more air exchanges per hour, and the dashed line represents clinical personnel at low-risk hospitals and nonclinical personnel, exposed to all air exchange rates. The latter data were truncated after 20 years because there were too few participants.

Grahic Jump Location
Grahic Jump Location
Figure 2.
Kaplan–Meier analysis of time from hiring to tuberculin conversion among all participants, stratified by level of air exchange in respiratory isolation rooms.ACPH

The solid line represents clinical personnel at increased-risk hospitals with fewer than six air exchanges per hour ( ), the dotted line represents clinical personnel at increased-risk hospitals with six or more air exchanges per hour, and the dashed line represents clinical personnel at low-risk hospitals and nonclinical personnel, exposed to all air exchange rates. The latter data were truncated after 20 years because there were too few participants.

Grahic Jump Location

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Hospital Ventilation and Tuberculosis in Canadian Health Care Workers

Copyright ©2004 by the American College of Physicians

Read More...

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)