Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-28T00:48:24.389Z Has data issue: false hasContentIssue false
  • English
  • Français

Low Risk for Tuberculosis in a Regional Pediatric Hospital: Nine-Year Study of Community Rates and the Mandatory Employee Tuberculin Skin-Test Program

Published online by Cambridge University Press:  31 March 2016

Celia D.C. Christie ,
Panayiota Constantinou ,
Mary L. Marx ,
Mary Jane Willke ,
Kathleen Marot ,
Fernando L. Mendez ,
James Donovan  and
Julia Thole
Celia D.C. Christie*
Affiliation:
Division of Infectious Diseases, Children's Hospital Medical Center, Cincinnati, Ohio Division of Epidemiology, Children's Hospital Medical Center, Cincinnati, Ohio Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
Panayiota Constantinou
Affiliation:
Division of Infectious Diseases, Children's Hospital Medical Center, Cincinnati, Ohio
Mary L. Marx
Affiliation:
Division of Epidemiology, Children's Hospital Medical Center, Cincinnati, Ohio
Mary Jane Willke
Affiliation:
Employee Health, Children's Hospital Medical Center, Cincinnati, Ohio
Kathleen Marot
Affiliation:
Hamilton County Tuberculosis Control, Cincinnati, Ohio
Fernando L. Mendez
Affiliation:
Hamilton County Tuberculosis Control, Cincinnati, Ohio
James Donovan
Affiliation:
Employee Health, Children's Hospital Medical Center, Cincinnati, Ohio
Julia Thole
Affiliation:
Employee Health, Children's Hospital Medical Center, Cincinnati, Ohio
*
Children's Hospital Medical Center, Division of Infectious Diseases, CH 1371, 3333 Burnet Avenue, Cincinnati, OH 45229-3039
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To assess the risk of Mycobacterium tuberculosis infection and disease among patients and workers in a regional pediatric hospital.

Design:

Descriptive epidemiological study of the mandatory tuberculin skin testing program of hospital employees at hire and during annual reevaluation, pediatric patients with tuberculosis (TB), efficacy of hospital infection control measures, and community rates of TB.

Setting:

361-bed, university, pediatric hospital serving Cincinnati (1.7 million population).

Results:

During 1986 through 1994, 2,275 to 4,356 employees were compliant with Mantoux skin testing and screening each year. This represented >97% of the population who were eligible for screening. The cumulative rate of M tuberculosis infection from a previous positive tuberculin skin test was 10% to 12% per year during 1986 through 1994. Among new Mantoux skin-test converters in employees at annual reevaluation, the risk of TB infection was 0.3% in 1993 and 1994. There were no active cases of TB identified during new employee screening or annual reevaluation. Of 62 new Mantoux skin-test converters in 9 years, 23% were foreign-born, 13% were Asian, 23% were African American, 11% received the bacillus of Calmette-Guerin vaccine, and 60% had direct patient care or indirect patient contact. A cluster of five converters occurred in a department with no patient care or contact. Mantoux conversion rates were 1.9 per 1,000 employee patient-care or contact-years and 2.2 per 1,000 employee non-patient-contact years. Twenty pediatric patients with active TB were identified during 1991 to 1994, with ≤6 cases per year, placing this hospital in the low-risk category for M tuberculosis disease. Three children with pulmonary TB were admitted without immediate respiratory isolation, possibly exposing 9 patients and 42 employees; none converted their Mantoux skin tests on retesting. Rates of active TB in Cincinnati were stable during the period (eg, 8/100,000 population in 1994).

Conclusions:

Despite intense active surveillance among thousands of hospital employees with >97% annual compliance, tuberculin conversion rates were low, and no cases of active TB were identified during 9 years of follow-up. There was no evidence of transmission of M tuberculosis from infected patients to employees during uncontrolled exposures. Rates of TB in the community were low. These data suggest that rigorous application of the Centers for Disease Control and Prevention guidelines and Occupation Safety and Health Administration regulations for preventing nosocomial TB in pediatric hospitals may be excessive and costly. Special provisions should be made for pediatric hospitals with a proven low risk of transmission of M tuberculosis

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 19 , Issue 3 , March 1998 , pp. 168 - 174
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1998

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. Bloom, BR. Tuberculosis: back to a frightening future. Nature 1992;358:538ߝ539.CrossRefGoogle ScholarPubMed
2. Tuberculosis morbidity-United States, 1992. MMWR 1993;42;363.Google Scholar
3. Centers for Disease Control and Prevention. Core Curriculum on Tuberculosis: What the Clinician Should Know. 3rd ed. Atlanta, GA: US Department of Health and Human Services, Public Health Service; 1994.Google Scholar
4. Centers for Disease Control and Prevention. Special report: TB infection control. Many hospitals unprepared as MDR-TB reported nationwide. Hospital Infection Control 1993:20:17ߝ32.Google Scholar
5. Centers for Disease Control. Nosocomial transmission of multiple-drug resistant tuberculosis among HIV-infected persons-Florida and New York, 1988-1991. MMWR 1991;40:585ߝ591.Google Scholar
6. Coronado, VG, Beck-Sague, CM, Hutton, MD, Davis, BJ, Nicholas, P, Villareal, C, et al. Transmission of multiple-drug resistant Mycobacterium tuberculosis among persons with human immunodeficiency virus infection in a urban hospital: epidemiologic and restriction fragment-length polymorphism analysis. J Infect Dis 1993;168:1052ߝ1055.CrossRefGoogle Scholar
7. Pearson, ML, Jereb, JA, Frieden, TR, Crawford, JT, Davis, BJ, Dooley, SW, et al. Nosocomial transmission of multiple-drug resistant tuberculosis: a risk to patients and health care workers. Ann Intern Med 1992;117:191ߝ196.CrossRefGoogle Scholar
8. Beck-Sague, C, Dooley, SW, Hutton, MD, Otten, J, Breeden, A, Crawford, JT, et al. Hospital outbreak of multiple-drug resistant Mycobacterium tuberculosis infections: factors in transmission to staff and HIV-infected patients. JAMA 1992;268:1280ߝ1286.CrossRefGoogle Scholar
9. Edlin, BR, Tokars, JI, Grieco, MH, Crawford, JT, Williams, J, Sordillo, EM, et al. An outbreak of multiple-drug resistant tuberculosis among hospitalized patents with the acquired immunodeficiency syndrome. N Engl J Med 1992;326:1514ߝ1521.CrossRefGoogle Scholar
10. Valway, S, Pearson, ML, Ikeda, R, Edlin, BR. HIV-infected (HIV+) health care workers with multiple-drug resistant tuberculosis (MDR-TB), 1990-92. In: Programs and Abstracts of the 33rd Interscience Conference on Antimicrobial Agents and Chemotherapy; 10 17-20, 1993; New Orleans, LA. Washington, DC: American Society for Microbiology 1993:231. Abstract.Google Scholar
11. Myers, JA. The prevention of tuberculosis among nurses. Am J Nurs 1930;30:1361ߝ1372.Google Scholar
12. American Thoracic Society. Statement: control of tuberculosis. Am Rev Resp Dis 1983;128:336ߝ342.Google Scholar
13. Williams, WW. CDC guidelines of infection control for hospital personnel. Infect Control 1983;4:336ߝ337.Google Scholar
14. Centers for Disease Control and Prevention. Guidelines for preventing transmission of Mycobacterium tuberculosis in health-care facilities, 1994. MMWR 1994;43(RR-13):1ߝ132.Google Scholar
15. Menzies, D, Fanning, A, Yuan, L, Fitzgerald, M. Tuberculosis among health care workers. N Engl J Med 1995;332:92ߝ98.CrossRefGoogle ScholarPubMed
16. Price, LE, Rutala, WA, Samsa, GP. Tuberculosis in hospital personnel. Infect Control 1987;8:97ߝ101.CrossRefGoogle ScholarPubMed
17. Craven, RB, Wenzel, RP, Atuk, N. Minimizing tuberculosis risk to hospital personnel and students exposed to unsuspected disease. Ann Intern Med 1975;82:628ߝ632.CrossRefGoogle ScholarPubMed
18. Berman, J, Levin, ML, Orr, ST, Desi, L. Tuberculosis risk for hospital employees: analysis of a five year tuberculin skin testing program. Am J Public Health 1981;71:1217ߝ1222.CrossRefGoogle ScholarPubMed
19. Vogeler, DM, Burke, JP. Tuberculosis screening for hospital employees: a five year experience in a large community hospital. Am Rev Resp Dis 1978;117:227ߝ232.Google Scholar
20. Ruben, FL, Norden, CW, Shuster, N. Analysis of a community hospital employees tuberculosis screening program 31 months after its inception. Am Rev Respir Dis 1977;115:23ߝ28.Google ScholarPubMed
21. Chan, JC, Tabak, JI. Risk of tuberculosis infection among house-staff in an urban teaching hospital. South Med J 1985;78:1061ߝ1064.CrossRefGoogle Scholar
22. Aitken, ML, Anderson, KM, Albert, RK. Is the tuberculosis screening program of hospital employees still required? Am Rev Respir Dis 1987;136:805ߝ807.CrossRefGoogle ScholarPubMed
23. Raad, I, Cusick, J, Sheretz, RJ, Sabbaugh, M, Howell, N. Annual tuberculin skin testing of employees in a university hospital: a cost benefit analysis. Infect Control and Hosp Epidemiol 1989;10:465ߝ469.CrossRefGoogle Scholar
24. Malasky, C, Jordan, T, Potulski, F, Reichman, LB. Occupational tuberculous infections among pulmonary physicians in training. Am Rev Respir Dis 1990;142:505ߝ507.CrossRefGoogle ScholarPubMed
25. Condos, R, Schulger, N, Lacoutre, R, Rom, W. Tuberculosis infections among housestaff at Bellevue hospital in an epidemic period. Am Rev Respir Dis 1993;147(suppl):A124. Abstract.Google Scholar
26. Redwood, E, Anderson, V, Felton, CP, Findlay, S, Ford, JG. Tuberculin conversions in hospital employees in a high tuberculosis prevalence area. Am Rev Respir Dis 1993;147:(suppl):A119. Abstract.Google Scholar
27. Ramirez, AJ, Anderson, P, Herp, S, Raff, MJ. Increased rate of tuberculin test conversions among workers in a university hospital. Infect Control Hosp Epidemiol 1992;13:579ߝ581.CrossRefGoogle Scholar
28. Adal, KA, Anglim, AM, Palumbo, CL, Titus, MG, Coyner, BJ, Farr, BM. The use of high efficiency particulate air-filter respirators to protect hospital workers from tuberculosis-a cost effectiveness analysis. N Engl J Med 1994;331:169ߝ173.CrossRefGoogle ScholarPubMed
29. Starke, JR, Jacobs, RF, Jereb, J. Resurgence of tuberculosis in children. J Pediatr 120:839ߝ843;1992.CrossRefGoogle ScholarPubMed
30. Rabalais, G, Adams, G, Stover, B. PPD skin test conversion in health care workers after exposure to Mycobacterium tuberculosis in infants. Lancet 1991;8770:338:826.CrossRefGoogle Scholar
31. Wright, HP, MeLellan, UW. Tuberculosis in childhood: contagion on the part of the child. Acta Paediatr Scand 1937;22:273.CrossRefGoogle Scholar
32. Starke, JR. Tuberculosis. In: Behrman, RE, Kliegman, RM, Arvin, AM, eds. Nelson Textbook of Pediatrics. 15th ed. Philadelphia, PA: W.B. Saunders and Co; 1995:834ߝ846.Google Scholar
33. Weinstein, JW, Barrett, CR, Baltimore, RS, Hierholzer, WJ. Nosocomial transmission of tuberculosis from a hospital visitor on a pediatric ward. Pediatr Infec Dis J 1995;14:232ߝ234.CrossRefGoogle Scholar
34. George, RH, Gully, PR, Gill, ON, Innes, JA, Bakhshi, SS, Connoly, M. An outbreak of tuberculosis in a children's hospital. J Hosp Infect 1986;8:129ߝ142.CrossRefGoogle ScholarPubMed
35. Aznar, J, Safi, H, Romeroa, J, Alejo, A, Garcia, A, Palomares, J. Nosocomial transmission of tuberculosis infection in pediatric wards. Pediatr Infec Dis J 1995;14:44ߝ48.CrossRefGoogle Scholar
36. Pope, AS. An outbreak of tuberculosis in infants due to hospital infection. J Pediatr 1942;20:297ߝ300.CrossRefGoogle Scholar
37. Stewart, CJ. Tuberculosis infection in a pediatric department. Br Med J 1976;1:30ߝ32.CrossRefGoogle Scholar
38. Christie, CD, Thole, J, Marx, M, Willke, MJ, Donovan, J. Improving influenza vaccine delivery to hospital employees by linkage to the annual mandatory tuberculin skin testing program in a 361-bed, regional, midwest, pediatric hospital. Platform presentation. International Conference on Antimicrobial Agents and Chemotherapy; 09 1995; San Francisco, CA. Abstract J108.Google Scholar
39. Christie, CD, Thole, J, Willke, MJ, Donovan, J. Influenza vaccination linked to annual mandatory tuberculin skin testing improves influenza vaccine delivery to employees in a 361-bed regional, pediatric hospital. Poster presentation. The Society for Healthcare Epidemiology of America. 04 1995; San Diego, CA. Abstract M98.Google Scholar
40. Roy, M, Fredrickson, M, Good, N, Hunter, SA, Nettleman, M. Correlation between frequency of tuberculosis and compliance with control strategies. Infect Control Hosp Epidemiol 1997;18:28ߝ31.CrossRefGoogle ScholarPubMed
41. Johnson, JL, Nyole, S, Shepardson, L, Mugereva, R, Ellner, JJ. Simultaneous comparison of two commercial tuberculin skin test reagents in an area with a high prevalence of tuberculosis. J Infect Dis 1995;171:1066ߝ1067.CrossRefGoogle Scholar
42. Shands, JW, Boeff, D, Fauerbach, L, Gutekunst, RR. Tuberculin testing in a tertiary hospital: product variability. Infect Control Hosp Epidemiol 1994;15:758ߝ760.CrossRefGoogle Scholar
43. McKenna, MT, McCray, E, Onorato, M. The epidemiology of tuberculosis among foreign-born persons in the United States, 1986 to 1993. N Engl J Med 1995;332:1071ߝ1076.CrossRefGoogle ScholarPubMed
44. Vartesesian-Karanfil, L, Josephson, A, Fikrig, S, Kauffman, S. Steinder, P. Pulmonary infection and cavity formation caused by Mycobacterium tuberculosis in a child with AIDS. N Engl J Med 1988;319:1018, 1019.Google Scholar
45. Adal, KA, Anglim, AM, Palumbo, CL, Titus, MG, Coyner, BJ, Farr, BM. The use of high-efficiency particulate respirators to protect hospital workers from tuberculosis: a cost effectiveness analysis. N Engl J Med 1994;331:169ߝ173.CrossRefGoogle ScholarPubMed
46. Nettleman, MD, Friedrickson, M, Good, NL, Hunter, SA. Tuberculosis control strategies: the cost of particulate respirators. Ann Intern Med 1994;121:37ߝ40.CrossRefGoogle ScholarPubMed
47. Raad, I, Cusick, J, Sherertz, RJ, Sabbagh, M, Howell, N. Annual tuberculin skin testing of employees at a university hospital: a cost benefit analysis. Infect Control Hosp Epidemiol 1989:10;465ߝ469.CrossRefGoogle Scholar
48. Lowenthal, G, Keys, T. Tuberculosis surveillance in hospital employees are we doing too much? Infect Control 1986;7:209ߝ211.CrossRefGoogle Scholar