Hostname: page-component-745bb68f8f-g4j75 Total loading time: 0 Render date: 2025-01-14T12:45:57.809Z Has data issue: false hasContentIssue false
  • English
  • Français

Reduction in Tuberculin Skin-Test Conversions Among Medical House Staff Associated with Improved Tuberculosis Infection Control Practices

Published online by Cambridge University Press:  02 January 2015

David R. Bangsberg ,
Kathleen Crowley ,
Andrew Moss ,
Jay F. Dobkin ,
Carlton McGregor  and
Harold C. Neu
David R. Bangsberg*
Affiliation:
Columbia-Presbyterian Medical Center, New York City, New York
Kathleen Crowley
Affiliation:
Columbia-Presbyterian Medical Center, New York City, New York
Andrew Moss
Affiliation:
Department of Epidemiology and Biostatistics, San Francisco General Hospital, University of California-San Francisco
Jay F. Dobkin
Affiliation:
Columbia-Presbyterian Medical Center, New York City, New York
Carlton McGregor
Affiliation:
Columbia-Presbyterian Medical Center, New York City, New York
Harold C. Neu
Affiliation:
Columbia-Presbyterian Medical Center, New York City, New York
*
Center for AIDS Prevention Studies, A Component of the AIDS Research Institute, University of California –San Francisco, Box 0886, 74 New Montgomery St, Suite 600, San Francisco, CA 94105-0886
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To assess the efficacy of an infection control program as measured by tuberculin skin-test (TST) conversion rates in medical house staff.

Design:

Observational study.

Setting:

University-based hospital in New York City serving a large indigent population.

Participants:

Medical house staff.

Interventions:

TST conversions were measured every 6 months in medical house staff from June 1992 to June 1994. Compliance with the isolation policy was measured by identifying room locations 24 hours after admission of patients who had Mycobacterium tuberculosis recovered from respiratory specimens.

Results:

The TST conversion rate decreased from 5.8 to 0, 2.3, and 0 per 100 person years of exposure in successive 6-month periods. The estimated annual TST conversion rate among interns fell from 7 per 100 person years in June 1992 to 0 per 100 person years in June 1993 and 0 per 100 person years in June 1994 (P=.029). The proportion of patients with pulmonary tuberculosis who were isolated in negative-pressure rooms increased from 38% to 75% over the study period (P=.01).

Conclusion:

Development of a multifaceted infection control program can decrease the risk of nosocomial tuberculosis infection in medical house staff.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 18 , Issue 8 , August 1997 , pp. 566 - 570
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1997

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Centers for Disease Control and Prevention. Tuberculosis control laws—United States; recommendations of the advisory council for the elimination of tuberculosis. MMWR 1993:42:RR15:1–28.Google Scholar
2. New York City Department of Health. Tuberculosis in NYC, 1991. New York, NY: NYCDH; 1991.Google Scholar
3. Frieden, TR, Sterling, T, Pablos-Mendez, A, et al. The resurgence of drug resistant tuberculosis in New York City. N Engl J Med 1993;328:521–526.CrossRefGoogle Scholar
4. Goble, M, Iseman, MD, Madsen, LA, et al. Treatment of 171 patients with pulmonary tuberculosis resistant to isoniazid and rifampin. N Engl J Med 1993;328:527–532.CrossRefGoogle ScholarPubMed
5. Ehrenkranz, NJ, Kicklighter, JL. Tuberculosis outbreak in a general hospital: evidence for airborne spread of infection. Ann Intern Med 1972;77:377–382.CrossRefGoogle Scholar
6. Craven, RB, Wenzel, RP, Nuhzet, AO. Minimizing tuberculosis risk to hospital personnel and students exposed to unsuspected disease. Ann Intern Med 1975;82:628–632.CrossRefGoogle ScholarPubMed
7. Catanzaro, A. Nosocomial tuberculosis. Am Rev Respir Dis 1992;125:559–562.CrossRefGoogle Scholar
8. Haley, CE, McDonald, RC, Rossi, LR, et al. Tuberculosis epidemic among hospital personnel. Infect Control Hosp Epidemiol 1989;10:204–210.Google Scholar
9. Pearson, ML, Jereb, JA, Frieden, TR, Crawford, JT, et al. Nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis . Ann Intern Med 1992;117:191–196.Google Scholar
10. Edlin, BR, Tokars, JI, Grieco, MH, et al. An outbreak of multidrug-resistant tuberculosis among hospitalized patients with the acquired immunodeficiency syndrome. N Engl J Med 1991;326:1514–1521.CrossRefGoogle Scholar
11. Daley, CL, Small, PF, Schecter, GK, et al. An outbreak of tuberculosis with accelerated progression among persons infected with HIV virus: an analysis using restriction length polymorphisms. N Engl J Med 1992;326:231–235.CrossRefGoogle Scholar
12. Centers for Disease Control. Nosocomial transmission of multidrug-resistant tuberculosis among HIV infected persons—Florida and New York, 1988-1991. MMWR 1991;40:585–591.Google Scholar
13. Vogler, DM, Burke, JP. Tuberculosis screening in hospital employees. Am Rev Respir Dis 1978;117:227–232.Google Scholar
14. Blumberg, HM, Dan, LW, Watkins, PA-C, et al. Preventing the nosocomial transmission of tuberculosis. Ann Intern Med 1995;122:658–663.CrossRefGoogle ScholarPubMed
15. Shands, JW Jr, Boeff, D, Fauerbach, L, Gutekunst, RR. Tuberculin testing in a tertiary hospital: product variability. Infect Control Hosp Epidemiol 1994;15:758–760.Google Scholar
16. Centers for Disease Control and Prevention. Draft guidelines of preventing the transmission of tuberculosis in health-care facilities. 2nd ed. Federal Register 1993;58:52809–52854.Google Scholar
17. Nettleman, ND, Fredrickson, M, Good, N, Hunter, A. Tuberculosis strategies: the cost of particulate respirators. Ann Intern Med 1994;121:37–40.Google Scholar
18. Maloney, SA, Pearson, ML, Gordon, MT, Castillo, RD, Boyle, JF, Jarvis, WR. Efficacy of control measures in preventing nosocomial transmission of multidrug-resistant tuberculosis to patients and health care workers. Ann Intern Med 1995;122:90–95.Google Scholar
19. Nuzhet, AO, Hunt, EH. Serial tuberculin testing and isoniazid therapy in general hospital employees. JAMA 1971;218:1795–1798.Google Scholar
20. Barrett-Connor, E. The epidemiology of tuberculosis in physicians. JAMA 1979;241:33–38.CrossRefGoogle ScholarPubMed
21. Chan, JC, Tabak, JI. Risk of tuberculosis infection among house staff in an urban teaching hospital. South Med J 1985;78:1061–1064.CrossRefGoogle Scholar
22. Malaesky, C, Jordan, T, Potulski, F, Reicman, LB. Occupational tuberculosis infections among pulmonary physicians in training. Am Rev Respir Dis 1990;142:505–507.Google Scholar
23. Bowden, KM, McDiarmond, MA. Occupationally acquired tuberculosis: what's known. JOM 1994;36:320–325.Google Scholar
24. Selwyn, PA, Hartel, D, Lewis, VA, et al. A prospective study of the risk of tuberculosis among intravenous drug users with HIV infection. N Engl J Med 1989;320:545–550.CrossRefGoogle Scholar