title: Preventing the nosocomial transmission of tuberculosis.
abstract: OBJECTIVE
  To study the efficacy of expanded tuberculosis infection control measures consisting primarily of administrative controls.
  
  
  METHODS
  Descriptive case series.
  
  
  METHODS
  University-affiliated, inner-city hospital.
  
  
  METHODS
  Introduction of expanded tuberculosis infection control measures (including an expanded respiratory isolation policy).
  
  
  METHODS
  The number of tuberculosis exposure episodes and skin test conversion rates of health care workers were measured before and after implementation of expanded infection control measures. Tuberculosis exposure episodes (the number of patients who were not placed in respiratory isolation at admission but who subsequently had a diagnosis of acid-fast bacilli smear-positive pulmonary tuberculosis during that admission or within 2 weeks of discharge) were compared for two time periods: the 8 months before and the 28 months after implementation of infection control measures. Tuberculin skin test conversion rates among health care workers were evaluated during a 2.5-year period.
  
  
  RESULTS
  After expanded infection control measures were implemented, the number of tuberculosis exposure episodes decreased from 4.4 per month (35 episodes among 103 patient admissions for potentially infectious tuberculosis over 8 months) to 0.6 per month (18 episodes among 358 patient admissions for smear-positive pulmonary tuberculosis over 28 months) (odds ratio, 9.72; 95% CI, 4.99 to 19.25 [P < 0.001]). The cumulative number of days per month that potentially infectious patients with tuberculosis were not in isolation decreased from 35.4 to 3.3 (P < 0.001). A concomitant decrease in tuberculin skin test conversion rates in health care workers was seen; 6-month tuberculin skin test conversion rates decreased steadily from 3.3% (118 conversions in 3579 health care workers; 1/92 to 6/92), 1.7%, 1.4%, 0.6%, to 0.4% (23 conversions in 5153 workers [1/94 to 6/94]) (P < 0.001).
  
  
  CONCLUSIONS
  Infection control measures effectively prevented nosocomial transmission of tuberculosis to health care workers. Administrative controls appear to be the most important component of a tuberculosis infection control program and should be the first focus of such a program, especially at public hospitals, where resources are most likely to be limited.
authors.affiliation: Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA 30303, USA.
authors.forename: H M
authors.initials: HM
authors.lastname: Blumberg
authors.forename: D L
authors.initials: DL
authors.lastname: Watkins
authors.forename: J D
authors.initials: JD
authors.lastname: Berschling
authors.forename: A
authors.initials: A
authors.lastname: Antle
authors.forename: P
authors.initials: P
authors.lastname: Moore
authors.forename: N
authors.initials: N
authors.lastname: White
authors.forename: M
authors.initials: M
authors.lastname: Hunter
authors.forename: B
authors.initials: B
authors.lastname: Green
authors.forename: S M
authors.initials: SM
authors.lastname: Ray
authors.forename: J E
authors.initials: JE
authors.lastname: McGowan
mesh_terms: D000328:Adult; D003428:Cross Infection / Q000517:prevention & control* / Q000635:transmission; D005845:Georgia; D006785:Hospitals, University; D006786:Hospitals, Urban; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000517:prevention & control*; D010356:Patient Isolation; D010564:Personnel, Hospital; D011446:Prospective Studies; D012189:Retrospective Studies; D014374:Tuberculin Test; D014397:Tuberculosis, Pulmonary / Q000517:prevention & control* / Q000635:transmission