title: Tuberculosis in health care workers at a hospital with an outbreak of multidrug-resistant Mycobacterium tuberculosis.
abstract: OBJECTIVE
  Investigate reports of tuberculosis in health care workers employed at a hospital with an outbreak of multidrug-resistant Mycobacterium tuberculosis.
  
  
  METHODS
  Case series of tuberculosis in health care workers, January 1, 1989, through May 31, 1992. Antimicrobial susceptibility testing and restriction fragment length polymorphism analysis of M tuberculosis isolates. Longitudinal analysis of cumulative tuberculin skin test surveillance data. Assessment of infection control. The patients consisted of 361 health care workers who had either serial tuberculin skin tests or tuberculosis.
  
  
  RESULTS
  Six health care workers, the largest number linked to one multidrug-resistant tuberculosis outbreak, had disease due to M tuberculosis that matched the outbreak strain from hospitalized patients. The two who were seropositive for human immunodeficiency virus died, one of tuberculous meningitis and the other of multiple causes including tuberculosis. The estimated risk of a skin test conversion was positively associated with time and increased by a factor of 8.3 (1979 to 1992). In 1992 the annual risk for workers in the lowest exposure occupational group was 2.4%. In comparison, nurses and housekeepers had relative risks of 8.0 (95% confidence interval, 3.2 to 20.3) and 9.4 (95% confidence interval, 2.7 to 32.3), respectively. Laboratory workers had a relative risk of 4.2 (95% confidence interval, 1.1 to 15.5). Tuberculosis admissions increased, but the hospital had inadequate ventilation to isolate tuberculosis patients effectively. There were lapses in infection control practices.
  
  
  CONCLUSIONS
  Health care workers who were exposed during a hospital outbreak of multidrug-resistant tuberculosis had occupationally acquired active disease. The human immunodeficiency virus-infected health care workers with tuberculosis had severe disease and died. The risk of skin test conversion increased during the study period, and higher exposure occupations had elevated risk. Effective infection control is essential to prevent the transmission of tuberculosis to health care workers.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Ga., USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Jereb
authors.forename: R M
authors.initials: RM
authors.lastname: Klevens
authors.forename: T D
authors.initials: TD
authors.lastname: Privett
authors.forename: P J
authors.initials: PJ
authors.lastname: Smith
authors.forename: J T
authors.initials: JT
authors.lastname: Crawford
authors.forename: V L
authors.initials: VL
authors.lastname: Sharp
authors.forename: B J
authors.initials: BJ
authors.lastname: Davis
authors.forename: W R
authors.initials: WR
authors.lastname: Jarvis
authors.forename: S W
authors.initials: SW
authors.lastname: Dooley
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000635:transmission; D000328:Adult; D000368:Aged; D004196:Disease Outbreaks; D018432:Drug Resistance, Multiple; D006282:Health Personnel; D006761:Hospitals; D006801:Humans; D017053:Infection Control; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis; D011159:Population Surveillance; D014374:Tuberculin Test; D014376:Tuberculosis / Q000517:prevention & control / Q000635:transmission*