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August 7, 1995

Tuberculosis Surveillance of Community Hospital Employees: A Recommended Strategy

Author Affiliations

From the Departments of Medicine, Our Lady of Mercy Medical Center, Bronx, NY (Dr Ramaswamy), and the New York Medical College, Valhalla (Drs Corpuz and Hewlett).

Arch Intern Med. 1995;155(15):1637-1639. doi:10.1001/archinte.1995.00430150115012

Objective and Methods:  To suggest a cost-effective strategy with a high degree of surveillance for the transmission of tuberculosis infection to employees in community hospitals. We performed a cost-benefit analysis of tuberculin skin testing over a 4-year period. The setting was a community hospital in Bronx, NY. The subjects consisted of employees of the hospital who were categorized into high-risk employees defined as individuals who worked daily in patient care and low-risk employees defined as those not directly involved in patient care. All cases of tuberculin skin test conversion among employees were reviewed over a 4-year period. The departments involved, total number of employees, chest radiographic findings, and prophylaxis instituted were noted.

Results:  The number of employees who were screened over the past 4 years consisted of 897 in 1990, 857 in 1991, 1357 in 1992, and 1316 in 1993. The mean annual conversion rate was 1%, 1.5%, 1.7%, and 1.4% for the 4 years, respectively. Skin test conversions according to job description revealed that of the total number of conversions 42% were from the nursing staff, 6.2% among the physicians and residents, and 52% among the ancillary staff. There was no difference in conversion between medical and nonmedical services such as the gynecology and surgical floors.

Conclusion:  Since tuberculin conversion rates of high-risk employees and those exposed to infectious tuberculosis cases have been low, we suggest a comprehensive strategy of 6-month tuberculin testing for high-risk employees and yearly testing for low-risk employees and eliminating boosting and repeated testing at 12 weeks in those exposed to infectious cases of tuberculosis.(Arch Intern Med. 1995;155:1637-1639)

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