Protecting health care workers from tuberculosis: a 10-year experience.
BACKGROUND
Cook County Hospital (CCH) is an inner-city, large public hospital. Twenty-five percent of Chicago's tuberculosis (TB) cases are diagnosed at CCH. We wanted to review and analyze interventions implemented over a 10-year period at CCH to prevent TB infection in health care workers.


METHODS
We performed a retrospective review of interventions to prevent health care-associated tuberculosis. We collated and analyzed tuberculin skin test conversions in our employees for the same time period.


RESULTS
From 1990 to 2002, we cared for over 1800 in-patients with tuberculosis. During 1992-1997, multiple interventions to eliminate health care-associated spread of tuberculosis were implemented. Tuberculin skin test conversions in our employees decreased markedly from January 1994 through December 2002. Two drops in tuberculin skin test conversion rates occurred: one after introduction of basic administrative and engineering controls and a second after we experienced a decrease in missed TB cases and the introduction of N-95 personal respirators with 1-time qualitative fit testing.


CONCLUSIONS
Our annual health care worker skin test conversion rate fell significantly when our primary interventions were relatively simple administrative and engineering controls. Educating health care workers to promptly recognize patients with TB and placing exhaust fans to create negative-pressure respiratory isolation rooms were probably our 2 most potent infection control measures.
Welbel
Sharon F
SF
Department of Medicine/Infectious Disease, Rush Medical College, and John H Stroger Jr. Hospital of Cook County, Chicago, IL 60612, USA. sharon_welbel@rush.edu
French
Audrey L
AL
Bush
Patricia
P
DeGuzman
Delia
D
Weinstein
Robert A
RA
D002641:Chicago; D003428:Cross Infection / Q000517:prevention & control* / Q000635:transmission; D017408:Guidelines as Topic; D006801:Humans; D017053:Infection Control / Q000379:methods*; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000517:prevention & control*; D009784:Occupational Diseases / Q000517:prevention & control*; D010356:Patient Isolation; D010564:Personnel, Hospital / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014374:Tuberculin Test; D014397:Tuberculosis, Pulmonary / Q000517:prevention & control* / Q000635:transmission; D015919:Ventilators, Negative-Pressure