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Evaluating the Control of Tuberculosis Among Healthcare Workers: Adherence to CDC Guidelines of Three Urban Hospitals in California

Published online by Cambridge University Press:  02 January 2015

Patrice M. Sutton ,
Mark Nicas ,
Florence Reinisch  and
Robert J. Harrison
Patrice M. Sutton*
Affiliation:
Public Health Institute, Berkeley, California
Mark Nicas
Affiliation:
Center for Occupational and Environmental Health, School of Public Health, University of California, Berkeley, California
Florence Reinisch
Affiliation:
California Department of Health Services, Berkeley, California
Robert J. Harrison
Affiliation:
California Department of Health Services, Berkeley, California
*
Public Health Institute, 2151 Berkeley Way, Annex 11, Berkeley, CA 94704
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Abstract

OBJECTIVE:

To evaluate adherence to components of the Centers for Disease Control and Prevention (CDC) guidelines for preventing the transmission of Mycobacterium tuberculosis in healthcare facilities.

DESIGN:

Multihospital study using direct observation and a standardized questionnaire.

SETTING:

Three urban hospitals (two county hospitals and one private community hospital) in counties in California with a high number and incidence rate of tuberculosis (TB) cases.

MEASUREMENTS:

The ventilation performance of treatment and TB-patient isolation rooms was assessed. Questionnaire data regarding TB control policy and procedures were obtained through interviews with the person(s) responsible for each program component; review of written TB control plans, training, and educational materials; and attendance at hospital TB control meetings and trainings.

RESULTS:

Twenty-eight percent of isolation rooms tested (7/25) were under positive pressure; 83% of rooms tested (20/24) had six or more nominal air changes per hour (ACH), but supply air did not mix rapidly with room air. Therefore, the nominal ACH likely overestimated the effective ACH and the subsequent protection provided. In virtually all rooms tested (26/27), air potentially containing M tuberculosis aerosol moved toward, rather than away from likely worker locations. None of the hospitals regularly checked the performance of engineering controls. Only one hospital adhered to the CDC minimum requirements for respiratory protection. Training of healthcare workers generally was underutilized as a TB prevention measure. Hospitals did not provide comprehensive counseling regarding the need for healthcare workers to know their immune status and the risks associated with M tuberculosis infection in an immunocompromised individual. Employee representatives did not have a voice in TB-related decision making.

CONCLUSIONS:

Important aspects of day-to-day TB control practice did not conform to the written TB control policy. Subsequent to the identification of TB patients, healthcare workers at all three hospitals were potentially exposed to M tuberculosis aerosol due to breaches in negative-pressure isolation, the limitations of dilution ventilation, and the failure to maintain engineering controls and to implement respiratory protection controls fully These findings lend support to the Occupational Safety and Health Administration's policy presumption that, absent clear evidence to the contrary, newly acquired healthcare-worker M tuberculosis infections are work-related.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 19 , Issue 7 , July 1998 , pp. 487 - 493
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1998

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References

1. Centers for Disease Control and Prevention. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care facilities. MMWR 1994;(RR-13)43.Google Scholar
2. Sepkowitz, KA. Tuberculosis and the healthcare worker: a historical perspective. Ann Intern Med 1994;120:71–79.CrossRefGoogle ScholarPubMed
3. California Department of Health Services, Occupational Health Branch. Protocol for Evaluating Adherence to CDC Guidelines for Preventing Tuberculosis in Healthcare Facilities. Berkeley, CA: California Department of Health Services; 1994.Google Scholar
4. US Department of Labor. Respiratory protection. Occupational Safety and Health Administration publication 29 CFR 1910.34. Washington, DC: US Department of Labor.Google Scholar
5. Fraser, VJ, Johnson, K, Primack, J, Jones, M, Medoff, G, Dunagan, WC. Evaluation of rooms with negative pressure ventilation used for respiratory isolation in seven midwestern hospitals. Infect Control Hosp Epidemiol 1993;14:623–628.CrossRefGoogle ScholarPubMed
6. Beck-Sagué, C, Dooley, SW, Hutton, MD, Otten, 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
7. Blumberg, HM, Watkins, DL, Berschling, JD et al. Preventing the nosocomial transmission of tuberculosis. Ann Intern Med 1995;122(9):658–663.CrossRefGoogle ScholarPubMed
8. McDiarmid, M, Gamponia, MJ, Ryan, MAK, Hirshon, JM, Gillen, NA, Cox, M. Tuberculosis in the workplace: OSHA's compliance experience. Infect Control Hosp Epidemiol 1996;17:159–164.CrossRefGoogle ScholarPubMed
9. Ikeda, RM, Birkhead, GS, DiFerdinando, GT, Bornstein, DL, Dooley, SW, Kubica, GP, et al. Nosocomial tuberculosis: an outbreak of a strain resistant to seven drugs. Infect Control Hosp Epidemiol 1995;16:152–159.CrossRefGoogle ScholarPubMed
10. Tapper, ML. Where are we in tuberculosis infection control? Infect Control Hosp Epidemiol 1995;16:125–128.CrossRefGoogle ScholarPubMed
11. Hopkins, L. When control measures fail. Journal of PeriAnesthesia Nursing 1996:11:246–247.CrossRefGoogle ScholarPubMed
12. Kenyon, TA, Ridzon, R, Luskin-Hawk, R, Schultz, C, Paul, WS, Valway, SE, et al. A nosocomial outbreak of multidrug-resistant tuberculosis. Ann Intern Med 1997;127(1):32–36.CrossRefGoogle ScholarPubMed
13. Nicas, M. Respiratory protection and the risk of Mycobacterium tuberculosis infection. Am J Ind Med 1995;27:317–333.CrossRefGoogle ScholarPubMed
14. Kantor, HS, Poblete, R, Pusateri, SL. Nosocomial transmission of tuberculosis from unsuspecting disease. Am J Med 1988;84:833–838.CrossRefGoogle Scholar
15. Jagirdar, J, Zagzag, D. Pathology and insights into pathogenesis of tuberculosis. In: Rom, WN, Garay, S, eds. Tuberculosis. Boston, MA: Little, Brown and Co; 1996:467.Google Scholar
16. Green, FHY, Yoshida, K. Characteristics of aerosols generated during autopsy procedures and their potential role as carriers of infectious agents. Applied Occupational Environmental Hygiene 1990;5:853–857.CrossRefGoogle Scholar
17. Sloan, RA. The dissemination of tubercle bacilli from fresh autopsy material. New York State Journal of Medicine; 04 30, 1941.Google Scholar
18. Templeton, GL, Illing, LA, Young, L, Cave, D, Stead, WW, Bates, J. The risk of transmission of Mycobacterium tuberculosis at the bedside and during autopsy. Ann Intern Med 1995;122(12):922–925.CrossRefGoogle ScholarPubMed
19. National Institute of Occupational Safety and Health. Health Hazard Evaluation Report 92-171-2255. Syracuse, NY. Onondaga County Medical Examiner's Office; 1992.Google Scholar
20. Lundgren, R, Norrman, E, Asberg, I. Tuberculosis infection transmitted at autopsy. Tubercle 1987;68:147–150.CrossRefGoogle ScholarPubMed
21. Stead, WW. Tuberculosis transmission in closed institutions. In: Rom, WN, Garay, S, eds. Tuberculosis. Boston, MA: Little, Brown and Co; 1996:145.Google ScholarPubMed
22. Zaza, S, Blumberg, HM, Beck-Sagué, Haas WH, Woodley, CL, Pineda, M, et al. Nosocomial transmission of Mycobacterium tuberculosis: role of healthcare workers in outbreak propagation. J Infect Dis 1995;172:1542–1549.CrossRefGoogle ScholarPubMed
23. Sawyer, HJ. Occupational health concerns in the health care field. In: Patty's Industrial Hygiene and Toxicology 4th Edition, Part A, General Principles. New York, NY: John Wiley and Sons; 1991:371–372.Google Scholar
24. Gerberding, JL. Occupational infectious diseases or infectious occupational diseases? Bridging the views on tuberculosis control. Infect Control Hosp Epidemiol 1993;14:686–688.CrossRefGoogle ScholarPubMed
25. Sugarman, J, Terry, P, Faden, RR, Holmes, DE, Fogarty, L, Pyertiz, RE. Professional healthcare workers' attitudes toward treating patients with multidrug-resistant tuberculosis. The Journal of Clinical Ethics 1996;7(3):222–227.CrossRefGoogle ScholarPubMed
26. Fridkin, SK, Manangan, L, Bolyard, E, 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(3):135–140.CrossRefGoogle ScholarPubMed
27. Stroud, LA, Tokars, JI, Grieco, MH, Crawford, JT, Culver, DH, Edlin, BR, et al. Interruption of nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis among AIDS patients in a New York City hospital. Infect Control Hosp Epidemiol 1995;16:141–147.CrossRefGoogle Scholar
28. US Department of Labor, Occupational Safety and Health Administration. Enforcement procedures and scheduling for occupational exposure to tuberculosis. 02 9, 1996. OSHA Instruction CPL 2.106, p. 19. 29CFR 1904. Washington, DC: US Department of Labor.Google Scholar
29. Sepkowitz, KA, Friedman, CR, Hafiler, A, Kowk, D, Manoach, S, Floris, M, et al. Tuberculosis among urban heath care workers: a study using restriction fragment length polymorphism typing. Clin Infect Dis 1995;21:1098–1102.CrossRefGoogle Scholar