Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-12-01T02:52:00.820Z Has data issue: false hasContentIssue false
  • English
  • Français

Use and Efficacy of Tuberculosis Infection Control Practices at Hospitals With Previous Outbreaks of Multidrug-Resistant Tuberculosis

Published online by Cambridge University Press:  02 January 2015

Jerome I. Tokars ,
George F. McKinley ,
Joan Otten ,
Charles Woodley ,
Emilia M. Sordillo ,
Joan Caldwell ,
Catherine M. Liss ,
Mary Ellen Gilligan ,
Lois Diem  and
Ida M. Onorato
...Show all authors
Jerome I. Tokars*
Affiliation:
Division of Healthcare Quality Promotion, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
George F. McKinley
Affiliation:
St Lukes-Roosevelt Hospital Center, New York, New York
Joan Otten
Affiliation:
Jackson Memorial Hospital, Miami, Florida
Charles Woodley
Affiliation:
National Center for Infectious Diseases, Division of Tuberculosis Elimination, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
Emilia M. Sordillo
Affiliation:
St Lukes-Roosevelt Hospital Center, New York, New York
Joan Caldwell
Affiliation:
Jackson Memorial Hospital, Miami, Florida
Catherine M. Liss
Affiliation:
St Lukes-Roosevelt Hospital Center, New York, New York
Mary Ellen Gilligan
Affiliation:
St Lukes-Roosevelt Hospital Center, New York, New York
Lois Diem
Affiliation:
National Center for Infectious Diseases, Division of Tuberculosis Elimination, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
Ida M. Onorato
Affiliation:
National Center for Infectious Diseases, Division of Tuberculosis Elimination, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
William R. Jarvis
Affiliation:
Division of Healthcare Quality Promotion, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
*
Hospital Infections Program, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS E-55, Atlanta, GA30333
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To evaluate the implementation and efficacy of selected Centers for Disease Control and Prevention guidelines for preventing spread of Mycobacterium tuberculosis.

Design:

Analysis of prospective observational data.

Setting:

Two medical centers where outbreaks of multidrug-resistant tuberculosis (TB) had occurred.

Participants:

All hospital inpatients who had active TB or who were placed in TB isolation and healthcare workers who were assigned to selected wards on which TB patients were treated.

Methods:

During 1995 to 1997, study personnel prospectively recorded information on patients who had TB or were in TB isolation, performed observations of TB isolation rooms, and recorded tuberculin skin-test results of healthcare workers. Genetic typing of M tuberculosis isolates was performed by restriction fragment-length polymorphism analysis.

Results:

We found that only 8.6% of patients placed in TB isolation proved to have TB; yet, 19% of patients with pulmonary TB were not isolated on the first day of hospital admission. Specimens were ordered for acid-fast bacillus smear and results received promptly, and most TB isolation rooms were under negative pressure. Among persons entering TB isolation rooms, 44.2% to 97.1% used an appropriate (particulate, high-efficiency particulate air or N95) respirator, depending on the hospital and year; others entering the rooms used a surgical mask or nothing. We did not find evidence of transmission of TB among healthcare workers (based on tuberculin skin-test results) or patients (based on epidemiological investigation and genetic typing).

Conclusions:

We found problems in implementation of some TB infection control measures, but no evidence of healthcare-associated transmission, possibly in part because of limitations in the number of patients and workers studied. Similar evaluations should be performed at hospitals treating TB patients to find inadequacies and guide improvements in infection control.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 22 , Issue 7 , July 2001 , pp. 449 - 455
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2001

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.Jarvis, WR. Nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis. Am J Infect Control 1995;23:146–151.CrossRefGoogle ScholarPubMed
2.Beck-Sague, C, Dooley, SW, Hutton, MD, Often, J, Breeden, A, Crawford, JT, et al.Hospital outbreak of multidrug-resistant Mycobacterium tuberculosis infections. Factors in transmission to staff and HIV-infected patients. JAMA 1992;268:1280–1286.CrossRefGoogle ScholarPubMed
3.Edlin, BR, Tokars, JI, Grieco, MH, Crawford, JT, Williams, J, Sordillo, EM, et al.An outbreak of multidrug-resistant tuberculosis among hospitalized patients with the acquired immunodeficiency syndrome. N Engl J Med 1992;326:1514–1521.CrossRefGoogle ScholarPubMed
4.Maloney, SA, Pearson, ML, Gordon, MT, Del Castillo, R, 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.CrossRefGoogle ScholarPubMed
5.Stroud, LA, Tokars, JI, Grieco, MH, Crawford, JT, Culver, DH, Edlin, BR, et al.Evaluation of infection control measures in preventing the nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis in a New York City hospital. Infect Control Hosp Epidemiol 1995;16:141–147.CrossRefGoogle Scholar
6.Wenger, PN, Often, J, Breeden, A, Orfas, D, Beck-Sague, CM, Jarvis, WR. Control of nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis among healthcare workers and HIV-infected patients. Lancet 1995;345:235–240.CrossRefGoogle ScholarPubMed
7.Centers for Disease Control and Prevention. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care facilities, 1994. MMWR 1994;43(RR-13):1–132.Google Scholar
8.van Embden, JD, Cave, MD, Crawford, JT, Dale, JW, Eisenach, KD, Gicquel, B, et al.Strain identification of Mycobacterium tuberculosis by DNA fingerprinting: recommendations for a standardized methodology. J Clin Microbiol 1993;31:406–409.CrossRefGoogle ScholarPubMed
9.Burman, WJ, Reves, RR, Hawkes, AP, Rietmeijer, CA, Yang, Z, el Hajj, H, et al.DNA fingerprinting with two probes decreases clustering of Mycobacterium tuberculosis. Am J Respir Crit Care Med 1997;155:1140–1146.CrossRefGoogle ScholarPubMed
10.Menzies, D, Fanning, A, Yuan, L, Fitzgerald, M. Tuberculosis among health care workers. N Engl J Med 1995;332:93–98.CrossRefGoogle ScholarPubMed
11.Knirsch, CA, Jain, NL, Pablos-Mendez, A, Friedman, C, Hripcsak, G. Respiratory isolation of tuberculosis patients using clinical guidelines and an automated clinical decision support system. Infect Control Hosp Epidemiol 1998;19:94–100.CrossRefGoogle Scholar
12.Pegues, CF, Johnson, DC, Pegues, DA, Spencer, M, Hopkins, CC. Implementation and evaluation of an algorithm for isolation of patients with suspected pulmonary tuberculosis. Infect Control Hosp Epidemiol 1996;17:412–418.CrossRefGoogle ScholarPubMed
13.Blumberg, HM, Watkins DL Berschling, JD, Antle, A, Moore, P, White, N, et al.Preventing the nosocomial transmission of tuberculosis. Ann Intern Med 1995;122:658–663.CrossRefGoogle ScholarPubMed
14.Wurtz, R. Administrative controls for TB: keep doing what you've always done, and you'll get what you always got. Infect Control Hosp Epidemiol 1996;17:409–411.Google ScholarPubMed
15.Michele, TM, Cronin, WA, Graham, NM, Dwyer, DM, Pope, DS, Harrington, S, et al.Transmission of Mycobacterium tuberculosis by a fiberoptic bronchoscope. Identification by DNA fingerprinting. JAMA 1997;278:1093–1095.CrossRefGoogle ScholarPubMed
16.Bifani, PJ, Mathema, B, Liu, Z, Moghazeh, SL, Shopsin, B, Tempalski, B, et al.Identification of a W variant outbreak of Mycobacterium tuberculosis via population-based molecular epidemiology. JAMA 1999;282:2321–2327.CrossRefGoogle Scholar
17.French, AL, Welbel, SF, Dietrich, SE, Mosher, LB, Breall, PS, Paul, WS, et al.Use of DNA fingerprinting to assess tuberculosis infection control. Ann Intern Med 1998;129:856–861.CrossRefGoogle ScholarPubMed
18.Blumberg, HM, Sotir, M, Erwin, M, Bachman, R, Shulman, JA. Risk of house staff tuberculin skin test conversion in an area with a high incidence of tuberculosis. Clin Infect Dis 1998;27:826–833.CrossRefGoogle Scholar
19.Fridkin, S, Manangan, L, the Society for Healthcare Epidemiology of America, Jarvis, WR. SHEA-CDC TB survey, part II: efficacy of TB infection control programs at member hospitals, 1992. Infect Control Hosp Epidemiol 1995;16:135–140.CrossRefGoogle ScholarPubMed