Varied approaches to tuberculosis control in a multihospital system

Area of Science:

• Occupational Health
• Infectious Disease Control
• Public Health Policy

Background:

• Tuberculosis (TB) control in healthcare settings is crucial to prevent occupational transmission.
• Understanding current TB control policies and their effectiveness in non-outbreak hospital environments is essential.
• Variations in hospital practices may influence employee health outcomes related to TB exposure.

Purpose of the Study:

• To document tuberculosis (TB) control policies and procedures in diverse hospital settings.
• To identify any specific TB control practices associated with increased employee tuberculin skin-test conversion rates.
• To assess the effectiveness of existing TB control measures in preventing occupational TB transmission.

Main Methods:

• A survey of occupational health and infection control practitioners across 13 Midwest hospitals.
• Review of hospital records to determine TB patient numbers and employee tuberculin skin-test conversion rates.
• Functional testing of negative-pressure ventilation rooms using smoke-stick methods.

Main Results:

• All 13 hospitals had TB control plans and conducted annual employee skin testing, with positivity rates ranging from 0% to 1.0%.
• Negative-pressure ventilation rooms were present in 11 hospitals, with a median of 95% functioning effectively.
• No correlation was found between the type of respiratory protection used, the number of functional negative-pressure rooms, or hospital TB risk category and employee skin-test conversion rates.

Conclusions:

• Significant variability exists in tuberculosis (TB) control policies and procedures among hospitals.
• Despite policy variations, employee TB skin-test conversion rates were consistently low across the surveyed hospitals.
• Current TB control strategies appear effective in minimizing occupational TB transmission in non-outbreak hospital settings.