Occupational Risk Factors for Tuberculosis Among Healthcare Workers in KwaZulu-Natal, South Africa.
Tuberculosis is a known occupational hazard for healthcare workers (HCWs), especially in countries with a high burden of tuberculosis. It is estimated that HCWs have a 2- to 3-fold increased risk of developing tuberculosis compared with the general population. The objective of this study was to identify occupational risk factors for tuberculosis among HCWs in 3 district hospitals with specialized multidrug-resistant tuberculosis wards in KwaZulu-Natal, South Africa.



We conducted a case-control study of HCWs diagnosed with tuberculosis between January 2006 and December 2010. Cases and controls were asked to complete a self-administered questionnaire regarding potential risk factors for tuberculosis.



Of 307 subjects selected, 145 (47%) HCWs responded to the questionnaire; 54 (37%) tuberculosis cases and 91 (63%) controls. Cases occurred more frequently among clinical staff 46% (n = 25) and support staff 35% (n = 19). Thirty-two (26% [32/125]) HCWs were known to be infected with human immunodeficiency virus (HIV), including 45% (21/54) of cases. HCWs living with HIV (odds ratio [OR], 6.35; 95% confidence interval [CI], 3.54-11.37) and those who spent time working in areas with patients (OR, 2.24; 95% CI, 1.40-3.59) had significantly greater odds of developing tuberculosis, controlling for occupation, number of wards worked in, and household crowding.



HIV was the major independent risk factor for tuberculosis among HCWs in this sample. These findings support the need for HCWs to know their HIV status, and for HIV-infected HCWs to be offered antiretroviral therapy and isoniazid preventive therapy. Infection prevention and control should also be improved to prevent transmission of tuberculosis in healthcare settings to protect both HCWs and patients.
School of Nursing, Johns Hopkins University, Baltimore, Maryland.
Carrie
C
Tudor
TB Research Platform, South African Medical Research Council, Pretoria.
Martie L
ML
Van der Walt
Department of Communicable Diseases, KwaZulu-Natal Department of Health, Pietermaritzburg, South Africa.
Bruce
B
Margot
Division of Infectious Disease, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
Susan E
SE
Dorman
Nicholas School of Environment and Duke Global Health Institute, Duke University, Durham, North Carolina.
William K
WK
Pan
Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
Gayane
G
Yenokyan
School of Nursing, Johns Hopkins University, Baltimore, Maryland.
Jason E
JE
Farley
D000328:Adult; D016022:Case-Control Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006282:Health Personnel / Q000706:statistics & numerical data*; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000453:epidemiology*; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014376:Tuberculosis / Q000453:epidemiology*
HIV; South Africa; healthcare worker; occupational health; tuberculosis