title: Room size is the major determinant for tuberculin conversion in health care workers exposed to a multidrug-resistant tuberculosis patient.
abstract: OBJECTIVE
  Transmission of Mycobacterium tuberculosis (MTB) to health care workers (HCWs) still represents a public health concern. A total of 71 obstetric workers underwent contact tracing after recent workplace exposure to a highly infectious multidrug-resistant tuberculosis patient [i.e., index case (IC)]. Aim of the study was to identify the main exposure predictors for the risk of conversion through evaluation of tuberculin screening results.
  
  
  METHODS
  HCWs were investigated by a questionnaire (community, occupational, IC exposure risk factors) and tuberculin skin test screening.
  
  
  RESULTS
  Conversion was detected in 5 (8%) of the 63 exposed workers and was not associated with either community or previous work-related risk factors. According to risk assessment, tuberculin conversion was related to neither amount time of exposure, workshifts, nor number of contacts. Conversely, an exposure to the IC in different hospital rooms was found significantly different among converters compared to non-converters (chi (2), P = 0.004). In particular, conversion was associated with exposure in two (obstetric emergency room, ambulatory discharge) out of the nine contact environments. Tuberculin conversion rates were associated with the room cubations of the exposure environments (chi (2) for trend, P < 0.01) and with worker age. In a logistic regression model adjusted for age, the lower room cubation was found the strongest predictor for tuberculin conversion (OR = 2.46, P = 0.02).
  
  
  CONCLUSIONS
  The study shows that the factors affecting airborne mycobacterial dose (patient infectiousness, low sized confined rooms) were the major determinants for MTB transmission after a brief exposure to a highly infectious TB case.
authors.affiliation: Occupational Health Unit, Policlinico Hospital, 8th floor, room # 8.056, Via Largo del Pozzo 71, 41100 Modena, Italy. franchi.alberto@policlinico.mo.it
authors.forename: Alberto
authors.initials: A
authors.lastname: Franchi
authors.forename: Luca
authors.initials: L
authors.lastname: Richeldi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Parrinello
authors.forename: Giuliano
authors.initials: G
authors.lastname: Franco
mesh_terms: D000328:Adult; D018432:Drug Resistance, Multiple; D005260:Female; D006282:Health Personnel; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000032:analysis*; D007558:Italy; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000302:isolation & purification*; D009774:Obstetrics; D016273:Occupational Exposure; D011795:Surveys and Questionnaires; D014374:Tuberculin Test; D014376:Tuberculosis / Q000175:diagnosis / Q000635:transmission*