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Evaluation of Infection Control Measures in Preventing the Nosocomial Transmission of Multidrug-Resistant Mycobacterium tuberculosis in a New York City Hospital

Published online by Cambridge University Press:  02 January 2015

Leonardo A. Stroud ,
Jerome I. Tokars ,
Michael H. Grieco ,
Jack T. Crawford ,
David H. Culver ,
Brian R. Edlin ,
Emilia M. Sordillo ,
Charles L. Woodley ,
Mary Ellen Gilligan  and
Nancy Schneider
...Show all authors
Leonardo A. Stroud
Affiliation:
Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia
Jerome I. Tokars*
Affiliation:
Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia
Michael H. Grieco
Affiliation:
St. Luke's-Roosevelt Hospital, New York, New York
Jack T. Crawford
Affiliation:
Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
David H. Culver
Affiliation:
Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia
Brian R. Edlin
Affiliation:
Division of HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia
Emilia M. Sordillo
Affiliation:
St. Luke's-Roosevelt Hospital, New York, New York
Charles L. Woodley
Affiliation:
Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Mary Ellen Gilligan
Affiliation:
St. Luke's-Roosevelt Hospital, New York, New York
Nancy Schneider
Affiliation:
St. Luke's-Roosevelt Hospital, New York, New York
Julie Williams
Affiliation:
St. Luke's-Roosevelt Hospital, New York, New York
William R. Jarvis
Affiliation:
Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Hospital Infections Program, Centers for Disease Control, Mailstop E-69, Atlanta, GA 30033
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Abstract

Objective:

To evaluate the efficacy of Centers for Disease Control and Prevention (CDC)-recommended infection control measures implemented in response to an outbreak of multidrug-resistant (MDR) tuberculosis (TB).

Design:

Retrospective cohort studies of acquired immunodeficiency syndrome (AIDS) patients and healthcare workers. The study period (January 1989 through September 1992) was divided into period I, before changes in infection control; period II, after aggressive use of administrative controls (eg, rapid placement of TB patients or suspected TB patients in single-patient rooms); and period III, while engineering changes were made (eg, improving ventilation in TB isolation rooms).

Setting:

A New York City hospital that was the site of one of the first reported outbreaks of MDR-TB among AIDS patients in the United States.

Participants:

All AIDS patients admitted during periods I and II. Healthcare workers on nine inpatient units with TB patients and six without TB patients.

Results:

The epidemic (38 patients) waned during period II and only one MDR-TB patient presented during period III. The MDR-TB attack rate among AIDS patients hospitalized on the same ward on the same days as an infectious MDR-TB patient was 8.8% (19 of 216) during period I, decreasing to 2.6% (5 of 193; P= 0.01) during period II. In a small group of healthcare workers with tuberculin skin test data, conversions during periods II through III were higher on wards with than without TB patients (5 of 29 versus 0 of 15; P= 0.15), although the difference was not statistically significant.

Conclusions:

Transmission of MDR-TB among AIDS patients decreased markedly after enforcement of readily implementable administrative measures, ending the outbreak. However, tuberculin skin-test conversions among healthcare workers may not have been prevented by these measures. CDC guidelines for prevention of nosocomial transmission of TB should be implemented fully at all US hospitals.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 16 , Issue 3 , March 1995 , pp. 141 - 147
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1995

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References

1. Catanzaro, A. Nosocomial tuberculosis. Am Rev Respir Dis 1982;125:559–562.CrossRefGoogle ScholarPubMed
2. Haley, CE, McDonald, RC, Rossi, L, Jones, J WD, Haley, RW, Luby, JI? Tuberculosis epidemic among hospital personnel. Infect Control Hosp Epidemiol 1989;10:204–210.Google Scholar
3. Di Perri, G, Cruciani, M, Danzi, MC, et al. Nosocomial epidemic of active tuberculosis among HIV-infected patients. Lancer 1989;2:1502–1504.Google Scholar
4. Dooley, SW, Villarino, ME, Lawrence, M, et al. Nosocomial transmission of tuberculosis in a hospital unit for HIV-infected patients. JAMA 1992;267:2632–2634.Google Scholar
5. Beck-Same, C. Doolev, SW. Hutton, MD. et al. Hospital outbreak of multidrug-resistant-Mycobacterium tuberculosis infections: factors in transmission to staff and HIV-infected patients. JAMA 1992;268:1280–1286.Google Scholar
6. Edlin, BR, Tokars, JI, Grieco, MH, et al. An outbreak of multidrug-resistant tuberculosis among hospitalized patients with the acauired immunodeficiencv syndrome. N Engl J Med 1992;326:1514–1521.CrossRefGoogle Scholar
7. Jereb, J, Dooley, S, Klevens, R, et al. Nosocomial transmission of multidrug-resistant tuberculosis to healthcare workers, New York City. In: World Congress on Tuberculosis A-ogram and Abstracts; November 1619, 1992; Bethesda, Maryland. Abstract 51A.Google Scholar
8. Pearson, ML, Jereb, JA, Frieden, TR, et al. Nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis: a risk to patients and healthcare workers. Ann Intern Med 1992;117:191–196.CrossRefGoogle Scholar
9. Ikeda, RM, Birkhead, G, DiFerdinando, G Jr, Bornstein, D, Morse, D. Nosocomial transmission of multidrug-resistant tuberculosis, New York. In: Abstracts of the Epidemic Intelligence Service Conference, Atlanta, April 6-10, 1992. Washington, DC: US Department of Health and Human Services; 1992:29.Google Scholar
10. Coronado, VG, Beck-Sague, CM, Hutton, MD, et al. Transmission of multidrug-resistant Mycobacterium tuberculosis among persons with human immunodeficiency virus infection in an urban hospital: epidemiologic and restriction fragment length polymorphism analysis J Infect Dis 1993;168:1052–1055.Google Scholar
11. Valway, S, Papania, M, Richards, J, et al. Multidrug resistant tuberculosis (MDR-TB) in New York State (NYS) correctional facilities, 19901991. Presented at the World Congress on Tuberculosis; November 1619, 1992; Bethesda, Maryland. Abstract 54B.Google Scholar
12. Coronado, VG, Valway, S, Finelli, L, et al. Nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis among intravenous drug users with human immunodeficiency virus infection. Presented at the Third Annual Meeting of The Society for Hospital Epidemiology of America; April 18-20. 1993; Chicago, Illinois. Abstract S50.Google Scholar
13. Centers for Disease Control and Prevention. Outbreak of multidrug-resistant tuberculosis at a hospital-New York City, 1991. MMWR 1993;42:427–434.Google Scholar
14. Centers for Disease Control and Prevention. Guidelines for prevention of TB Transmission in Hospitals. Atlanta, GA: US Department of Health and Human Services, Public Health Service; 1982; DHHS publication no. (CDC) 82-8371.Google Scholar
15. Garner, JS, Simmons, BP Guideline for isolation precautions in hospitals. Infect Control 1983;4:245–325.Google ScholarPubMed
16. Centers for Disease Control and Prevention. Guidelines for preventing the transmission of tuberculosis in health-care settings, with special focus on HIV-related issues. MMWR 1990;39(RR-17).Google Scholar
17. Centers for Disease Control and Prevention. National action plan to combat multidrug-resistant tuberculosis. MMWR 1992;41 (RR 11):1–48.Google Scholar
18. Centers for Disease Control and Prevention. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care facilities-1994. MMWR 1994;43(RR-13).Google Scholar
19. Tokars, JI, Jarvis, WR, Edlin, BR, et al. Tuberculin skin testing of hospital employees during an outbreak of multidrug-resistant tuberculosis in HIV-infected patients. Infect Control Hosp Epidemiol 1992:509–510.Google Scholar
20. Centers for Disease Control and Prevention. Revision of the CDC surveillance case definition for acquired immunodeficiency syndrome. MMWR 1987;36:3S–14S.Google Scholar
21. Cave, MD, Eisenach, KD, McDermott, PE, Bates, JH, Crawford, JT. IS6110: conservation of sequence in the Mycobacterium tuberculosis complex and its utilization in DNA figerprinting. Molecular and Cellular Probes 1991;5:73–80.Google Scholar
22. Wenger, PN, Otten, J, Breeden, A, Orfas, D, Beck-Sague, CM, Jarvis, WR. Control of nosocomial transmission of multidrug resistant Mycobacterium tuberculosis among health care workers and HIV-infected patients. Luncet 1995;345:235–240.10.1016/S0140-6736(95)90228-7Google Scholar
23. 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;122:92–95.CrossRefGoogle ScholarPubMed