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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
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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

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