Use and efficacy of tuberculosis infection control practices at hospitals with previous outbreaks of multidrug-resistant tuberculosis.
OBJECTIVE
To evaluate the implementation and efficacy of selected Centers for Disease Control and Prevention guidelines for preventing spread of Mycobacterium tuberculosis.


METHODS
Analysis of prospective observational data.


METHODS
Two medical centers where outbreaks of multidrug-resistant tuberculosis (TB) had occurred.


METHODS
All hospital inpatients who had active TB or who were placed in TB isolation and healthcare workers who were assigned to selected wards on which TB patients were treated.


METHODS
During 1995 to 1997, study personnel prospectively recorded information on patients who had TB or were in TB isolation, performed observations of TB isolation rooms, and recorded tuberculin skin-test results of healthcare workers. Genetic typing of M tuberculosis isolates was performed by restriction fragment-length polymorphism analysis.


RESULTS
We found that only 8.6% of patients placed in TB isolation proved to have TB; yet, 19% of patients with pulmonary TB were not isolated on the first day of hospital admission. Specimens were ordered for acid-fast bacillus smear and results received promptly, and most TB isolation rooms were under negative pressure. Among persons entering TB isolation rooms, 44.2% to 97.1% used an appropriate (particulate, high-efficiency particulate air or N95) respirator, depending on the hospital and year; others entering the rooms used a surgical mask or nothing. We did not find evidence of transmission of TB among healthcare workers (based on tuberculin skin-test results) or patients (based on epidemiological investigation and genetic typing).


CONCLUSIONS
We found problems in implementation of some TB infection control measures, but no evidence of healthcare-associated transmission, possibly in part because of limitations in the number of patients and workers studied. Similar evaluations should be performed at hospitals treating TB patients to find inadequacies and guide improvements in infection control.
Tokars
J I
JI
From the Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
McKinley
G F
GF
Otten
J
J
Woodley
C
C
Sordillo
E M
EM
Caldwell
J
J
Liss
C M
CM
Gilligan
M E
ME
Diem
L
L
Onorato
I M
IM
Jarvis
W R
WR
D000293:Adolescent; D000328:Adult; D000368:Aged; D002487:Centers for Disease Control and Prevention, U.S.; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D004196:Disease Outbreaks; D005431:Florida / Q000453:epidemiology; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D015658:HIV Infections / Q000453:epidemiology; D006801:Humans; D017053:Infection Control / Q000592:standards*; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000235:genetics / Q000302:isolation & purification; D009518:New York / Q000453:epidemiology; D010356:Patient Isolation / Q000706:statistics & numerical data; D010564:Personnel, Hospital; D011110:Polymorphism, Genetic / Q000235:genetics; D011446:Prospective Studies; D012134:Respiratory Protective Devices / Q000706:statistics & numerical data; D014374:Tuberculin Test / Q000706:statistics & numerical data; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology / Q000517:prevention & control*; D014481:United States / Q000453:epidemiology