Tuberculosis in hospital personnel

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Occupational Health

Background:

• Tuberculosis (TB) remains a significant public health concern, necessitating surveillance of infection risks in healthcare settings.
• Understanding TB infection prevalence and transmission dynamics among hospital employees is crucial for effective control strategies.

Purpose of the Study:

• To assess TB skin testing practices, infection prevalence, and associated risks among hospital employees in North Carolina.
• To determine if TB infection among hospital staff is primarily an occupational hazard or reflects community prevalence.

Main Methods:

• A statewide survey of 167 North Carolina hospitals assessed TB skin testing protocols and employee infection data.
• Data analysis included pre-employment testing rates, Mantoux method usage, interpretation criteria, booster test frequency, and TB infection prevalence.
• Correlation analysis examined the relationship between employee infection rates, conversion rates, and county/regional TB case rates.

Main Results:

• 98% of hospitals performed pre-employment TB skin tests, predominantly using the Mantoux method.
• TB infection prevalence among new employees was 6.3% (260/4137), with a 5-year mean conversion rate of 1.14% across 71,253 personnel.
• Employee TB infection prevalence and conversion rates showed a positive correlation with community TB case rates, suggesting a link to general population incidence.

Conclusions:

• The incidence of TB infection among North Carolina hospital employees appears to mirror community tuberculosis prevalence rather than indicating a significant occupational risk.
• Annual TB skin testing may be particularly warranted in high-incidence areas of eastern North Carolina, where the risk of new TB infection among hospital staff is elevated.