Tuberculosis surveillance of community hospital employees. A recommended strategy

To suggest a cost-effective strategy with a high degree of surveillance for the transmission of tuberculosis infection to employees in community hospitals. We performed a cost-benefit analysis of tuberculin skin testing over a 4-year period. The setting was a community hospital in Bronx, NY. The subjects consisted of employees of the hospital who were categorized into high-risk employees defined as individuals who worked daily in patient care and low-risk employees defined as those not directly involved in patient care. All cases of tuberculin skin test conversion among employees were reviewed over a 4-year period. The departments involved, total number of employees, chest radiographic findings, and prophylaxis instituted were noted.

The number of employees who were screened over the past 4 years consisted of 897 in 1990, 857 in 1991, 1357 in 1992, and 1316 in 1993. The mean annual conversion rate was 1%, 1.5%, 1.7%, and 1.4% for the 4 years, respectively. Skin test conversions according to job description revealed that of the total number of conversions 42% were from the nursing staff, 6.2% among the physicians and residents, and 52% among the ancillary staff. There was no difference in conversion between medical and nonmedical services such as the gynecology and surgical floors.

Since tuberculin conversion rates of high-risk employees and those exposed to infectious tuberculosis cases have been low, we suggested a comprehensive strategy of 6-month tuberculin testing for high-risk employees and yearly testing for low-risk employees and eliminating boosting and repeated testing at 12 weeks in those exposed to infectious cases of tuberculosis.