Are US hospitals making progress in implementing guidelines for prevention of Mycobacterium tuberculosis transmission?
BACKGROUND
Outbreaks of tuberculosis (TB) in hospitals have occurred when the Centers for Disease Control and Prevention (CDC) guideline recommendations for preventing the transmission of Mycobacterium tuberculosis were not fully implemented.


OBJECTIVE
To determine whether US hospitals are making progress in implementing the CDC guidelines for preventing TB.


METHODS
In 1992, we surveyed all public (city, county, Veterans Affairs, and primary medical school-affiliated) US hospitals (n = 632) and 444 (20%) random samples of all private hospitals with 100 beds or more. In 1996, we resurveyed 136 random samples (50%) of all 1992 respondent hospitals with 6 or more TB admissions in 1991.


RESULTS
Of the 1076 hospitals surveyed in 1992, 763 (71%) respondents returned a completed questionnaire. Among these, 536 (71%) of 755 reported having rooms that met CDC criteria for acid-fast bacilli isolation, ie, negative air pressure, 6 or more air exchanges per hour, and air directly vented to the outside. The predominant respiratory protective device for health care workers was nonfitted surgical mask and attending physicians were infrequently (50%) included in tuberculin skin-testing programs. In the 1996 resurvey, 103 (76%) of 136 respondents returned a completed questionnaire. Of these, 99 (96%) reported having rooms that met CDC criteria for acid-fast bacilli isolation. The N95 respiratory protective devices were predominantly used by health care workers, and attending physicians were increasingly (69%) included in the hospitals' tuberculin skin-testing programs.


CONCLUSIONS
Most US hospitals are making progress in the implementation of CDC guidelines for preventing the transmission of M tuberculosis.
Hospital Infections Program, National Center for Infectious Diseases, and Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. lpm2@cdc.gov
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Manangan
D N
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Simonds
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Pugliese
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Kroc
S N
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Banerjee
J R
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Rudnick
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Steingraber
W R
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Jarvis
D002487:Centers for Disease Control and Prevention, U.S.; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006739:Hospital Administration / Q000592:standards* / Q000706:statistics & numerical data; D006749:Hospital Design and Construction; D016304:Hospitals, Private / Q000592:standards; D006779:Hospitals, Public / Q000592:standards; D006801:Humans; D017053:Infection Control / Q000592:standards / Q000706:statistics & numerical data*; D010356:Patient Isolation / Q000639:trends; D010564:Personnel, Hospital; D017410:Practice Guidelines as Topic; D012134:Respiratory Protective Devices / Q000706:statistics & numerical data; D014374:Tuberculin Test / Q000706:statistics & numerical data; D014376:Tuberculosis / Q000517:prevention & control* / Q000635:transmission; D014481:United States