The costs of healthcare worker respiratory protection and fit-testing programs.
OBJECTIVE
We studied hospital costs associated with healthcare worker (HCW) respiratory protection and respirator fit-testing programs recommended by the Centers for Disease Control and Prevention (CDC) and mandated by the Occupational Safety and Health Administration to decrease nosocomial or occupational Mycobacterium tuberculosis (TB).


METHODS
The number and cost of high-efficiency particulate air (HEPA)-filter and dust-mist (DM) respirators for 1989 to 1994 were obtained from study hospital purchasing departments, and the costs of HCW fit-testing and education programs for 1994 were estimated from information provided by infection control practitioners. Costs of N-class respirator programs were estimated for study hospitals using retrospective cost analysis and an observational study.


METHODS
Four urban hospitals with, and one rural community hospital without, documented nosocomial or occupational transmission of multidrug-resistant TB.


RESULTS
During the study period, four of five hospitals introduced HEPA and DM respirators and respirator education and fit-testing programs. Median costs in 1994 were $83,900 (range, $2,000-$223,000) for respirators and $17,187 (range, $8,736-$26,175) for respiratory fit-testing programs. The projected median annual cost of N95 respirators was $62,023 (range, $270-$422,526).


CONCLUSIONS
Compliance with CDC TB guidelines may require a substantial investment. However, outlays for respirators and education and fit-testing programs are more reasonable than would be suggested by analyses that estimated the costs of preventing one case of nosocomial TB.
Kellerman
S E
SE
Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. sek0@cdc.gov
Tokars
J I
JI
Jarvis
W R
WR
D003428:Cross Infection / Q000517:prevention & control; D004196:Disease Outbreaks / Q000191:economics / Q000517:prevention & control; D004865:Equipment and Supplies, Hospital / Q000191:economics; D005431:Florida; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006780:Hospitals, Rural / Q000191:economics; D006786:Hospitals, Urban / Q000191:economics; D006801:Humans; D017053:Infection Control / Q000191:economics* / Q000379:methods; D007318:Inservice Training / Q000191:economics*; D009329:Nebraska; D009519:New York City; D016273:Occupational Exposure / Q000517:prevention & control*; D009786:Occupational Health Services / Q000191:economics; D010564:Personnel, Hospital / Q000193:education*; D011682:Purchasing, Hospital / Q000191:economics* / Q000706:statistics & numerical data; D012134:Respiratory Protective Devices / Q000191:economics*; D012189:Retrospective Studies; D014397:Tuberculosis, Pulmonary / Q000517:prevention & control*