Tracing patients exposed to health care workers with tuberculosis.
OBJECTIVE
Following an outbreak of tuberculosis (TB) among health care workers at a public hospital, the study was undertaken to (a) locate all exposed patients and administer tuberculin skin tests (TSTs) to them, (b) provide clinical treatment or prophylaxis to infected patients, and (c) ascertain the risk of M. tuberculosis transmission from health care workers to patients.


METHODS
The authors identified all patients who had been hospitalized on floors where health care workers with symptomatic TB worked. The staff of the hospital's outpatient HIV/AIDS clinic notified and evaluated clinic patients who had been hospitalized on those floors. County health department personnel attempted to contact the remaining patients by letter and phone.


RESULTS
The authors identified 586 patients hospitalized during the health care worker outbreak, of whom 503 were potentially susceptible. Of these, 172 (34.2%) could be contacted, and 138 (80.2%) completed tuberculin skin testing or other follow-up evaluation. Of 134 who completed testing, 28 (20.9%) had reactive TSTs. In all, 362 patients (72%) were lost to follow-up, including many HIV-positive and homeless patients, who are at high risk of developing active TB once infected with M. tuberculosis.


CONCLUSIONS
The reemergence of TB as a public health threat and the emergence of other infectious diseases make it imperative to elicit accurate addresses and contact information from hospitalized patients and to develop better methods of contacting patients after hospital discharge.
Zaza
S
S
Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Beck-Sagué
C M
CM
Jarvis
W R
WR
D016358:Contact Tracing; D003428:Cross Infection; D004196:Disease Outbreaks; D005500:Follow-Up Studies; D005845:Georgia / Q000453:epidemiology; D006779:Hospitals, Public; D006801:Humans; D017757:Infectious Disease Transmission, Professional-to-Patient / Q000517:prevention & control; D012306:Risk; D012882:Skin Tests; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology* / Q000635:transmission*