Hostname: page-component-586b7cd67f-rcrh6 Total loading time: 0 Render date: 2024-11-30T21:30:08.008Z Has data issue: false hasContentIssue false
  • English
  • Français

Tuberculosis Infection Among Staff at a Canadian Community Hospital

Published online by Cambridge University Press:  02 January 2015

Gary M. Liss ,
Ruth Khan ,
Esther Koven  and
Andrew E. Simor
Gary M. Liss*
Affiliation:
Health and Safety Studies Unit, Ontario Ministry of Labour, Sunnybrook Health Science Centre, University of Toronto, Toronto, Canada
Ruth Khan
Affiliation:
North York Branson Hospital, Sunnybrook Health Science Centre, University of Toronto, Toronto, Canada
Esther Koven
Affiliation:
North York Branson Hospital, Sunnybrook Health Science Centre, University of Toronto, Toronto, Canada
Andrew E. Simor
Affiliation:
Department of Microbiology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Canada
*
Health and Safety Studies Unit, Ontario Ministry of Labour, 7th Floor, 400 University Ave, Toronto, ON, Canada M7A 1T7
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To determine risks for tuberculin skin-test conversion among employees of a community hospital in Ontario, Canada.

Design:

Cohort morbidity study.

Setting:

Of 14 metropolitan Toronto area hospitals surveyed for data on tuberculin skin-test conversions, only one provided tuberculosis (TB) test data on all employees. Between 1991 and June 1994, 24 patients were treated at this hospital for pulmonary TB.

Population Studied:

The population at risk included those on staff from January 1991 through December 1993 who previously were skin-test negative; they were followed until the end of June 1994. Exposure was estimated (a) based on ranking departments according to an estimate of the number of hours of direct patient contact during a typical day, and (b) based on location of sputum-positive patients.

Outcome Measure:

Risks of skin-test conversion among hospital employees with documented prior negative skin tests.

Main Results:

A total of 809 skin-test negative employees were followed for 2,084 person-years; 18 employees with skin-test conversions were identitled. The overall conversion rate was 0.9% per year (0.86 per 100 person-years). After excluding two conversions attributed to contact with coworkers, the relative risk of conversion was 4.5 (5.5 after adjusting for age and gender) among those in the highest exposure category (≥4 hours per day), compared to those in departments ranked as having the lowest exposure (<2 hours per day). Among those working in wards in which sputum-positive patients were treated, 2.4% converted; the risk of conversion was over six times greater than among those working on wards with no TB patients or in departments with no patient contact, of whom 0.4% converted. Among the emergency room staff, the department in which the greatest number of sputum-positive patients were treated, at least 5% of staff converted. In those instances in which conversions were associated with exposure to a specific TB patient, the involved patients had been in the hospital for at least 4 days prior to being isolated.

Conclusions:

These results indicate that even in a hospital with few admissions due to tuberculosis, skin-test conversions associated with occupational exposure may occur.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 17 , Issue 1 , January 1996 , pp. 29 - 35
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1996

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. American Thoracic Society. Control of tuberculosis in the United States. Am Rev Respir Dis 1992;146:1622–1633.Google Scholar
2. FitzGerald, M. Epidemiology of tuberculosis in Canada. In: National Workshop on Tuberculosis, HIV and Other Emerging Issues. Ottawa, ON: Health Canada; 05 3-5, 1993:7–8.Google Scholar
3. Edlin, BR, Tokars, JI, Grieco, MH, et al. An outbreak of multidrugresistant' tuberculosis among ‘hospitalized patients with the acquired immunodeficiency syndrome. N Engl J Med 1992;326:1514–1521.10.1056/NEJM199206043262302Google Scholar
4. Pearson, ML, Jereb, JA, Friden, TR, et al. Nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis: a risk to patients and healthcare workers. Ann Intern Med 1992;117:191–196.10.7326/0003-4819-117-3-191CrossRefGoogle Scholar
5. Beck-Sague, C, Dooley, SW, Hutton, MD, et al. Hospital outbreak of multidrug-resistant Mycobacterium tuberculosis infections. Factors in transmission to staff and HIV-infected patients. JAMA 1992;268:1280–1286.10.1001/jama.1992.03490100078031CrossRefGoogle ScholarPubMed
6. 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;168:1052–1055.10.1093/infdis/168.4.1052CrossRefGoogle Scholar
7. Markowitz, SB. Epidemiology of tuberculosis among health care workers. Occup Med 1994;9(4):589–608.Google Scholar
8. Centers for Disease Control and Prevention. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care facilities, 1994. MMWR 1994;43(No. RR-13):1–132.Google Scholar
9. Jarvis, WR, Bolvard, EA. Bozzi, CT. et al. Respirators, recommendations, and regulations: the controversy surrounding protection of healthcare workers from tuberculosis. Ann Intern Med 1995;122:142–146.10.7326/0003-4819-122-2-199501150-00011CrossRefGoogle ScholarPubMed
10. Occupational Safety and Health Administration. Enforcement Policy and Procedures for Occupational Exposure to Tuberculosis. Memorandum by Roger A Clark, Directorate of Compliance Programs, OSHA. 10 1993.Google Scholar
11. Ashley, MJ, Wigle, WD. The epidemiology of active tuberculosis in hospital employees in Ontario, 1966-1969. Am Rev Respir Dis 1971;104:851–860.Google Scholar
12. American Thoracic Society. Diagnostic standards and classification of tuberculosis. Am-Rev Respir Dis 1990;142:725–735.10.1164/ajrccm/142.3.725Google Scholar
13. Coleman, M, Douglas, A, Herman, C, Peto, J. Cohort study analysis with a Fortran computer program. Int J Epidemiol 1986;15:134–137.10.1093/ije/15.1.134Google Scholar
14. Bowden, KM, McDiarmid, MA. Occupationally acquired tuberculosis: what's known. J Occup Med 1994;36:320–325.10.1097/00043764-199403000-00009CrossRefGoogle ScholarPubMed
15. Sepkowitz, KA. Tuberculosis and the health care worker: a historical perspective. Ann Intern Med 1994;120:71–79.10.7326/0003-4819-120-1-199401010-00012Google Scholar
16. Menzies, D, Fanning, A, Yuan, L, Fitzgerald, M. Tuberculosis among health care workers. N Engl J Med 1994;332:92–98.10.1056/NEJM199501123320206CrossRefGoogle Scholar
17. Fajan, MJ, Poland, GA. Tuberculin skin testing in medical students: a survey of US medical schools. Ann Intern Med 1994;120:930–931.10.7326/0003-4819-120-11-199406010-00005CrossRefGoogle Scholar
18. Perri, GD, Cadeo, GP, Castelli, F, et al Transmission of HIV-associated tuberculosis to health-care workers. Lancet 1992;340:682.10.1016/0140-6736(92)92227-7CrossRefGoogle ScholarPubMed
19. Centers for Disease Control and Prevention. Probable transmission of multidrug-resistant tuberculosis in a correctional facility--California. MMWR 1993;42:48–51.Google Scholar
20. Onorato, I. Tuberculosis in the United States. Multiple drugresistant TB in the US. In: National Workshop on Tuberculosis, HIV and Other Emerging Issues. Ottawa, ON: Health Canada; 05 3-5, 1993:2–3.Google Scholar
21. Styblo, K. The estimation of the annual risk of tuberculosis infection. Bull Int Union Tuberc 1978;51(suppl):1–101.Google Scholar
22. Becker, H. An ‘outbreak’ of tuberculin converters in a residential care facility. Geriatric Medicine Quarterly 1989;3:179, 188, 190-191, 194-195, 203.Google Scholar
23. Jereb, JA, Elevens, RM, Privett, TD, et al. Tuberculosis in health care workers at a hospital with an outbreak of multidrug-resistant Mycobacterium tuberculosis . Arch Intern Med 1995;155:854–859.10.1001/archinte.1995.00430080100012CrossRefGoogle Scholar
24. Berman, J, Levin, ML, Tangerose, S, Desi, L. Tuberculosis risk for hospital employees: analysis of a five-year tuberculin skintesting program. Am J Public Health 1981;71:1217–1222.10.2105/AJPH.71.11.1217Google Scholar
25. Faden, HS, Lee, J, Ogra, PL. Employee health screening in pediatric hospital. NY State J Med 1979;79:1708–1711.Google Scholar
26. Statistics Canada. Tuberculosis Statistics, 1992. Ottawa, ON: Statistics Canada; 1994 (Catalogue no. 82-220).Google Scholar
27. Ontario Ministry of Health. Epidemiology of tuberculosis in Ontario, 1989-1992. Public Health and Epidemiology Report. Public Health Branch, Ontario Ministry of Health; 1994;5(3):63–72.Google Scholar
28. Bailey, TC, Fraser, VJ, Spitznagel, EL, Dunagan, WC. Risk factors for a positive tuberculin skin test among employees of an urban, midwestern teaching hospital. Ann Intern Med 1995;122:580–585.10.7326/0003-4819-122-8-199504150-00004Google Scholar
29. Moline, JM, Markowitz, SB. Medical surveillance for workers exposed to tuberculosis. Occup Med 1994;9(4):695–721.Google ScholarPubMed
30. 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;331:169–173.10.1056/NEJM199407213310306CrossRefGoogle ScholarPubMed
31. Nettleman, MD, Fredrickson, M, Good, NL, Hunter, SA. Tuberculosis control strategies: the cost of particulate respirators. Ann Intern Med 1994;121:37–40.10.7326/0003-4819-121-1-199407010-00007Google Scholar
32. Fanning, EA, Menzies, R. Surveillance of medical students for TB urged. Can Med Assoc J 1995;152:328. Letter.Google Scholar