Tuberculosis surveillance of community hospital employees. A recommended strategy.
OBJECTIVE
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.


RESULTS
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.


CONCLUSIONS
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.
Ramaswamy
R
R
Department of Medicine, Our Lady of Mercy Medical Center, Bronx, NY, USA.
Corpuz
M
M
Hewlett
D
D
D000328:Adult; D003362:Cost-Benefit Analysis; D005260:Female; D006282:Health Personnel / Q000191:economics / Q000706:statistics & numerical data; D006764:Hospitals, Community / Q000191:economics; D006801:Humans; D007587:Job Description; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000379:methods; D008875:Middle Aged; D009519:New York City; D011159:Population Surveillance; D014374:Tuberculin Test / Q000191:economics; D014397:Tuberculosis, Pulmonary / Q000191:economics* / Q000517:prevention & control*