Status of Tuberculosis Infection Control Programs in Canadian Acute Care Hospitals, 1989 to 1993 – Part 1

Abstract

OBJECTIVE:To document tuberculosis (TB) prevention and control activities in Canadian acute care hospitals from 1989 to 1993. DESIGN: Retrospective questionnaire. PARTICIPANTS: All members of the Community and Hospital Infection Control Association-Canada and l'Association des professionnels pour la prévention des infections who lived in Canada and worked in an acute care hospital received a questionnaire. One questionnaire per hospital was completed. OUTCOME: The study documented the number of respiratory TB cases admitted to the hospital, the type of engineering and environmental controls available, and the type of occupational tuberculin skin test (TST) screening programs offered by the hospital. RESULTS: Questionnaires were received from 319 hospitals. Ninety-nine (32%) hospitals did not admit a respiratory TB case during the study. Thirty-one (10%) hospitals averaged six or more TB cases per year. TST results were reported for 47,181 health care workers, and 819 (1.7%) were reported as TST converters; physicians had a significantly higher TST conversion rate than other occupational groups. Most hospitals did not have isolation rooms with air exhausted outside the building, negative air pressure and six or more air changes per hour. Surgical masks were used as respiratory protection by 74% of staff. CONCLUSIONS: Canadian hospitals can expect to admit TB patients. Participating hospitals did not meet TB engineering or environmental recommendations published in 1990 and 1991. In addition, occupational TB screening programs in 1989 to 1993 did not meet Canadian recommendations published in 1988.

Job‐related risk of latent tuberculosis infection in a homogeneous population of hospital workers in a low incidence area

“…In the United States, 3.1% of all new TB cases were employed as a hospital worker in the 2 years before diagnosis [ATS/CDC/IDSA, 2005], and in New York State hospital personnel contributed approximately 4% of active disease cases after 10 years of declining TB incidence [Driver et al, 2005]. Furthermore, as transmission of MTB may be higher than expected even after casual contacts (10% risk of infection among non ''close contacts'' of a smear positive case and 2-3% risk among non ''close contacts'' of a smear negative case) screening program for LTBI of hospital employees is recommended [Holton et al, 1997;ATS/CDC/IDSA, 2005;Jensen et al, 2005].…”

Comparison of Tuberculosis Infection Control Programs in Canadian Hospitals Categorized by Size and Risk of Exposure to Tuberculosis Patients, 1989 to 1993 – Part 2

“…Part 1 of this study discusses reasons why the interpretation of the TST conversion rate data must be done cautiously (1). However, to disregard the TST data collected in this study is not appropriate.…”

“…This study documented that 68% of the hospitals participating in the study admitted at least one TB case during the study period (1). The study also showed that many hospitals did not meet published recommendations for tuberculin skin test (TST) screening programs for health care workers (HCWs) or recommendations for TB engineering and environmental controls (2)(3)(4).…”