Dramatic decrease in tuberculin skin test conversion rate among employees at a hospital in New York City.
BACKGROUND
The Centers for Disease Control and Prevention recently issued updated guidelines for preventing the transmission of tuberculosis in health care facilities. Many recommendations, including the use of high-efficiency particulate air filter respirators, are expensive to implement and of unproven efficacy. We therefore reviewed the tuberculin skin test conversion rate among our employees from 1991 to 1993, before introduction of high-efficiency particulate air filter respirators. During this period, several other improvements in tuberculosis control were implemented.


METHODS
Employee tuberculin test conversion rates were reviewed by 6-month interval from 1991 to 1993.


RESULTS
Throughout the study period, several tuberculosis control measures were implemented, including early isolation of patients with suspected cases of tuberculosis in rooms with negative-pressure ventilation, placement of germicidal UV light fixtures into patient rooms and common areas, and use of Technol shields (Technol, Inc., Fort Worth, Texas) (1991), particulate respirators (1992), and dust-mist-fume respirators (1993). With these improvements, the conversion rate among employees fell from 20.7% in the first 6 months of 1991 to 5.8% in the latter half of 1993.


CONCLUSIONS
The rate of skin test conversion among our employees decreased before introduction of high-efficiency particulate air filter respirators. This suggests that nosocomial spread of tuberculosis can be decreased by means of previously established, less costly methods.
Fella
P
P
Division of Infection Control, St. Clare's Hospital and Health Center, New York, NY, USA.
Rivera
P
P
Hale
M
M
Squires
K
K
Sepkowitz
K
K
D003428:Cross Infection / Q000517:prevention & control*; D005260:Female; D017408:Guidelines as Topic; D006284:Health Plan Implementation; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008297:Male; D009519:New York City; D010356:Patient Isolation; D010564:Personnel, Hospital / Q000706:statistics & numerical data*; D014374:Tuberculin Test / Q000706:statistics & numerical data*; D014376:Tuberculosis / Q000517:prevention & control*; D014397:Tuberculosis, Pulmonary / Q000517:prevention & control; D014466:Ultraviolet Rays; D015919:Ventilators, Negative-Pressure