SHEA-CDC TB Survey, Part I: Status of TB Infection Control Programs at Member Hospitals, 1989-1992

1995 ◽  
Vol 16 (3) ◽  
pp. 129-134
Author(s):  
Scott K. Fridkin ◽  
Lilia Manangan ◽  
Elizabeth Bolyard ◽  
William R. Jarvis ◽  
Keyword(s):  
Infection Control ◽  
Healthcare Workers ◽  
Skin Testing ◽  
Multidrug Resistant ◽  
Control Measures ◽  
Tuberculin Skin Testing ◽  
Respiratory Protection ◽  
Mdr Tb ◽  
Reported Data ◽  
Tb Infection Control

AbstractObjective:To determine trends in Mycobacterium tuberculosis infection in healthcare workers, tuberculosis (TB) control measures, and compliance with the 1990 Centers for Disease Control and Prevention (CDC) guideline for preventing transmission of TB in healthcare facilities.Design:Voluntary questionnaire sent to all members of the Society for Healthcare Epidemiology of America, representing 359 hospitals.Results:Respondents’ hospitals (210 [58%]) had a median of 2,400 healthcare workers (range, 396 to 13,745), 437 beds (range, 48 to 1,250), 5.6 patients with TB per year (range, 0 to 492), and 0 multidrug-resistant (MDR) TB patients per year (range, 0 to 33). Of 166 respondents’ hospitals for which data were provided for 1989 through 1992, the number caring for MDR-TB patients increased from 10 (6%) in 1989 to 49 (30%) in 1992. Reported policies for routine healthcare worker tuberculin skin testing varied. The median skin-test positivity rate for healthcare workers at the time of hire increased from 0.54% in 1989 to 0.81% in 1992, but the median conversion rate during routine testing remained similar: 0.35% in 1989 and 0.33% in 1992. Among 196 hospitals with reported data on respiratory protection use for 1989 through 1992, the use of either surgical submicron, dust-mist, or dust-fume-mist respirators for healthcare workers increased from 9 (5%) in 1989 to 85 (43%) in 1992. Of 181 hospitals with reported data, 113 (62%) had acid-fast bacilli isolation facilities consistent with the 1990 CDC guideline (ie, a single patient room, negative air pressure relative to the hallway, air exhausted directly outside, and ≥ 6 air exchanges per hour).Conclusions:While the number of surveyed hospitals caring for TB and MDR-TB patients increased during 1989 through 1992, TB infection control measures at many hospitals still did not meet the 1990 CDC guideline recommendations.

Tuberculosis in Hemodialysis Patients in New Jersey: A Statewide Study

1999 ◽  
Vol 20 (9) ◽  
pp. 607-609 ◽  
Author(s):  
Teresa A. Simon ◽  
Sindy Paul ◽  
Daniel Wartenberg ◽  
Jerome I. Tokars
Keyword(s):  
New Jersey ◽  
Infection Control ◽  
Healthcare Workers ◽  
Skin Testing ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Tuberculin Skin Testing ◽  
Control Policies ◽  
Newly Hired ◽  
Tb Infection Control

AbstractObjective:To study the incidence of tuberculosis (TB), tuberculin skin testing (TST) practices, and infection control practices at outpatient hemodialysis centers.Design:Mail surveys performed in December 1994 and 1995.Main Outcome Measures:The numbers of patients with incident active TB during 1994 and 1995, TST policies during 1994, and TB infection control policies in 1994.Setting:All outpatient dialysis centers in New Jersey.Patients or Participants:Healthcare workers and patients in dialysis centers in New Jersey.Results:Of 47 centers, 41 provided information on TST and TB infection control policies and practices. TSTs were performed on newly hired healthcare workers at all 41 centers and on established workers at 39 centers. In contrast, only 1 center reported performing TSTs on hemodialysis patients; 5 other centers reported screening of patients for TB using chest radiographs. Active TB was reported in 3 of 4,550 chronic hemodialysis patients in 1994 (rate, 66/100,000 patient-years) and in 4 of 4,831 patients in 1995 (rate, 83/100,000 patient-years). Both rates were several times higher than the rate in the New Jersey general population during this period (10.7-10.8/100,000).Conclusion:Although based on small numbers of patients with TB, we found a relatively high incidence of TB among hemodialysis patients in New Jersey. Most centers reported performing TSTs on workers but not on patients. These results suggest the need for improved TB screening and infection control precautions at outpatient dialysis centers.

Evaluation of Infection Control Measures in Preventing the Nosocomial Transmission of Multidrug-Resistant Mycobacterium tuberculosis in a New York City Hospital

1995 ◽  
Vol 16 (3) ◽  
pp. 141-147
Author(s):  
Leonardo A. Stroud ◽  
Jerome I. Tokars ◽  
Michael H. Grieco ◽  
Jack T. Crawford ◽  
David H. Culver ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
Infection Control ◽  
Healthcare Workers ◽  
Multidrug Resistant ◽  
Control Measures ◽  
City Hospital ◽  
Aids Patients ◽  
Infection Control Measures ◽  
Mdr Tb

AbstractObjective:To evaluate the efficacy of Centers for Disease Control and Prevention (CDC)-recommended infection control measures implemented in response to an outbreak of multidrug-resistant (MDR) tuberculosis (TB).Design:Retrospective cohort studies of acquired immunodeficiency syndrome (AIDS) patients and healthcare workers. The study period (January 1989 through September 1992) was divided into period I, before changes in infection control; period II, after aggressive use of administrative controls (eg, rapid placement of TB patients or suspected TB patients in single-patient rooms); and period III, while engineering changes were made (eg, improving ventilation in TB isolation rooms).Setting:A New York City hospital that was the site of one of the first reported outbreaks of MDR-TB among AIDS patients in the United States.Participants:All AIDS patients admitted during periods I and II. Healthcare workers on nine inpatient units with TB patients and six without TB patients.Results:The epidemic (38 patients) waned during period II and only one MDR-TB patient presented during period III. The MDR-TB attack rate among AIDS patients hospitalized on the same ward on the same days as an infectious MDR-TB patient was 8.8% (19 of 216) during period I, decreasing to 2.6% (5 of 193; P= 0.01) during period II. In a small group of healthcare workers with tuberculin skin test data, conversions during periods II through III were higher on wards with than without TB patients (5 of 29 versus 0 of 15; P= 0.15), although the difference was not statistically significant.Conclusions:Transmission of MDR-TB among AIDS patients decreased markedly after enforcement of readily implementable administrative measures, ending the outbreak. However, tuberculin skin-test conversions among healthcare workers may not have been prevented by these measures. CDC guidelines for prevention of nosocomial transmission of TB should be implemented fully at all US hospitals.

Trends in Compliance With the Guidelines for Preventing the Transmission of Mycobacterium tuberculosis Among New Jersey Hospitals, 1989 to 1996

1999 ◽  
Vol 20 (05) ◽  
pp. 337-340 ◽  
Author(s):  
Lilia P. Manangan ◽  
Edgar R. Collazo ◽  
Jerome Tokars ◽  
Sindy Paul ◽  
William R. Jarvis
Keyword(s):  
Mycobacterium Tuberculosis ◽  
New Jersey ◽  
Skin Testing ◽  
Multidrug Resistant ◽  
Tuberculin Skin Testing ◽  
Healthcare Facilities ◽  
Patient Admissions ◽  
Mdr Tb ◽  
Respiratory Devices ◽  
Attending Physicians

AbstractObjective:To determine trends in compliance with the guidelines for preventing the transmission ofMycobacterium tuberculosisin healthcare facilities among New Jersey hospitals from 1989 through 1996.Design:A voluntary questionnaire was sent to all 96 New Jersey hospitals in 1992. The 53 that responded were resurveyed in 1996.Results:Of the 96 hospitals surveyed in 1992, 53 (55%) returned a completed questionnaire; 33 (64%) were community, nonteaching hospitals. In 1991, patients with tuberculosis (TB) were admitted at 38 (72%) of 53 hospitals, and from 1989 through 1991, patients with multidrug-resistant (MDR) TB were admitted at 15 (29%) of 52 hospitals. Twenty-nine (57%) of 51 reported having rooms meeting the Centers for Disease Control and Prevention (CDC) criteria for acid-fast bacilli (AFB) isolation. A nonfltted surgical mask was used as a respiratory protective device by healthcare workers (HCWs) at 28 (55%) of 51 hospitals. Attending physicians were included in tuberculin skin-testing (TST) programs at 5 (11%) of 45 hospitals. In the 1996 resurvey, 48 (94%) of 53 surveyed hospitals returned a completed questionnaire; 34 (81%) of 42 had TB patient admissions, and 4 (9%) of 43 had MDR TB patient admissions in 1996. Forty-five (96%) of 47 reported having rooms that met CDC criteria for AFB isolation. N95 respiratory devices were used by HCWs at 45 (94%) of 48 hospitals. Attending physicians were included in the TST programs at 22 (54%) of 41 hospitals.Conclusion:New Jersey hospitals have made improvements in availability of AFB isolation rooms, use of proper respiratory protective devices, and expansion of TST programs for HCWs from 1989 through 1996.

Transmission of Multidrug-Resistant Mycobacterium tuberculosis Among Persons Exposed in a Medical Examiner's Office, New York

1995 ◽  
Vol 16 (3) ◽  
pp. 160-165
Author(s):  
Xilla T. Ussery ◽  
Jennifer A. Bierman ◽  
Sarah E. Valway ◽  
Teresa A. Seitz ◽  
George T. DiFerdinando ◽  
...  
Keyword(s):  
New York ◽  
Mycobacterium Tuberculosis ◽  
Skin Testing ◽  
Multidrug Resistant ◽  
Positive Tuberculin Skin Test ◽  
Positive Pressure ◽  
Tuberculin Skin Testing ◽  
Environmental Investigation ◽  
Environmental Controls ◽  
Mdr Tb

AbstractObjective:To determine the prevalence of and risk factors for having a positive tuberculin skin test (TST) result among employees at a medical examiner's office (MEO).Design:Cohort study, environmental investigation.Setting:Several employees at a medical examiner's office were found to have positive TST results after autopsies were performed on persons with multidrug-resistant tuberculosis (MDR-TB).Participants:Employees of the MEO.Results:Of 18 MEO employees, 5 (28%) had a positive TST result; 2 of these 5 had TST conversions. We observed a trend between TST conversion and participation in autopsies on persons with MDR-TB (2 of 2 converters versus 3 of 13 employees with negative TST; relative risk=4.3; 95% confidence interval 1.61 to 11.69; P=0.l0). The environmental investigation revealed that the autopsy room was at positive pressure relative to the rest of the MEO and that air from the autopsy room mixed throughout the facility.Conclusions:A systematic approach to preventing transmission of Mycobacterium tuberculosis in autopsy suites should include effective environmental controls and routine tuberculin skin testing of employees.

scholarly journals Tuberculosis infection control measures in healthcare facilities in Moyen-Ogooué Province, Gabon

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anja Vigenschow ◽  
Bayodé Romeo Adegbite ◽  
Jean-Ronald Edoa ◽  
Abraham Alabi ◽  
Akim A. Adegnika ◽  
...  
Keyword(s):  
Infection Control ◽  
Health Workers ◽  
Focal Point ◽  
Regional Hospital ◽  
Control Measures ◽  
Control Plan ◽  
Healthcare Facilities ◽  
Healthcare Settings ◽  
Mdr Tb ◽  
Tb Infection Control

Abstract Background Healthcare workers (HCW) are at higher risk of tuberculosis (TB) than the general population. We assessed healthcare facilities for their TB infection control standards and priorities. Methods A standardised tool was applied. The assessment was conducted by direct observation, documents review and interviews with the facility heads. Results Twenty healthcare facilities were assessed; 17 dispensaries, an HIV-clinic, a private not-for-profit hospital and a public regional hospital. In both hospitals, outpatient departments, internal medicine wards, paediatric wards, emergency departments; and the MDR-TB unit of the public regional hospital were assessed. In Gabon, there are currently no national guidelines for TB infection control (TBIC) in healthcare settings. Consequently, none of the facilities had an infection control plan or TBIC focal point. In three departments of two facilities (2/20 facilities), TB patients and presumed TB cases were observed to be consistently provided with surgical masks. One structure reported to regularly test some of its personnel for TB. Consultation rooms were adequately ventilated in six primary care level facilities (6/17 dispensaries) and in none of the hospitals, due to the use of air conditioning. Adequate personal protective equipment was not provided regularly by the facilities and was only found to be supplied in the MDR-TB unit and one of the paediatric wards. Conclusions In Moyen-Ogooué province, implementation of TBIC in healthcare settings is generally low. Consequently, HCW are not sufficiently protected and therefore at risk for M. tuberculosis infection. There is an urgent need for national TBIC guidelines and training of health workers to safeguard implementation.

Healthcare personnel experiences implementing carbapenem-resistant Enterobacterales infection control measures at a ventilator-capable skilled nursing facility—A qualitative analysis

2021 ◽  
pp. 1-7
Author(s):  
Katharina R. Rynkiewich ◽  
Jinal Makhija ◽  
Mary Carl M. Froilan ◽  
Ellen C. Benson ◽  
Alice Han ◽  
...  
Keyword(s):  
Infection Control ◽  
Multidrug Resistant ◽  
Control Measures ◽  
Healthcare Personnel ◽  
Skilled Nursing ◽  
Infection Control Measures ◽  
Carbapenem Resistant ◽  
Resident Care ◽  
Semistructured Interviews ◽  
Self Protection

Abstract Objective: Ventilator-capable skilled nursing facilities (vSNFs) are critical to the epidemiology and control of antibiotic-resistant organisms. During an infection prevention intervention to control carbapenem-resistant Enterobacterales (CRE), we conducted a qualitative study to characterize vSNF healthcare personnel beliefs and experiences regarding infection control measures. Design: A qualitative study involving semistructured interviews. Setting: One vSNF in the Chicago, Illinois, metropolitan region. Participants: The study included 17 healthcare personnel representing management, nursing, and nursing assistants. Methods: We used face-to-face, semistructured interviews to measure healthcare personnel experiences with infection control measures at the midpoint of a 2-year quality improvement project. Results: Healthcare personnel characterized their facility as a home-like environment, yet they recognized that it is a setting where germs were ‘invisible’ and potentially ‘threatening.’ Healthcare personnel described elaborate self-protection measures to avoid acquisition or transfer of germs to their own household. Healthcare personnel were motivated to implement infection control measures to protect residents, but many identified structural barriers such as understaffing and time constraints, and some reported persistent preference for soap and water. Conclusions: Healthcare personnel in vSNFs, from management to frontline staff, understood germ theory and the significance of multidrug-resistant organism transmission. However, their ability to implement infection control measures was hampered by resource limitations and mixed beliefs regarding the effectiveness of infection control measures. Self-protection from acquiring multidrug-resistant organisms was a strong motivator for healthcare personnel both outside and inside the workplace, and it could explain variation in adherence to infection control measures such as a higher hand hygiene adherence after resident care than before resident care.

scholarly journals Task-shifting directly observed treatment and multidrug-resistant tuberculosis injection administration to lay health workers: stakeholder perceptions in rural Eswatini

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Ernest Peresu ◽  
J. Christo Heunis ◽  
N. Gladys Kigozi ◽  
Diana De Graeve
Keyword(s):  
Healthcare Workers ◽  
Health Workers ◽  
Multidrug Resistant ◽  
Task Shifting ◽  
Tb Treatment ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Key Stakeholders ◽  
Mdr Tb ◽  
Directly Observed Treatment

Abstract Background Eswatini is facing a critical shortage of human resources for health (HRH) and limited access to multidrug-resistant tuberculosis (MDR-TB) treatment in rural areas. This study assessed multiple stakeholders’ perceptions of task-shifting directly observed treatment (DOT) supervision and administration of intramuscular MDR-TB injections to lay health workers (LHWs). Methods A mixed methods study comprising a cross-sectional survey using a semi-structured questionnaire with community treatment supporters (CTSs) and a focus group discussion with key stakeholders including representatives from the Eswatini Ministry of Health (MOH), donor organisations, professional regulatory institutions, nursing academia, civil society and healthcare providers was conducted in May 2017. Descriptive statistics, thematic content analysis and data triangulation aided in the interpretation of results. Results A large majority of CTSs (n = 78; 95.1%) were female and 33 (40.2%) were older than 50 years. Most (n = 7; 70.0%) key stakeholders had over 10 years of work experience in policy-making, advocacy in the fields of HRH or day-to-day practice in MDR-TB management. Task-shifting of MDR-TB injection administration was implemented without national policy guidance and regulation. Stakeholders viewed the strategy to be driven by the prevailing shortage of professional frontline HRH and limited access to MDR-TB treatment. Task-shifting was perceived to improve medication adherence, and reduce stigma and transport-related MDR-TB treatment access barriers. Frontline healthcare workers and implementing donor partners fully supported task-shifting. Policy-makers and other stakeholders accepted task-shifting conditionally due to fears of poor standards of care related to perceived incompetence of CTSs. Appropriate compensation, adequate training and supervision, and non-financial incentives were suggested to retain CTSs. A holistic task-shifting policy and collaboration between the MOH, academia and nursing council in regulating the practice were recommended. Conclusions Stakeholders generally accepted the delegation of DOT supervision and administration of intramuscular MDR-TB injections to LHWs as a strategy to increase access to treatment, albeit with some apprehension. Findings from this study stress that task-shifting is not a panacea for HRH shortages, but a short-term solution that must form part of an overall simultaneous strategy to train, attract and retain adequate numbers of professional healthcare workers in Eswatini. To address some of the apprehension and ambivalence about expanding access to MDR-TB services through task-shifting, attention should be paid to important aspects such as competence-based training, certification and accreditation, adequate supportive on-the-job supervision, recognition, compensation, and expediting policy and regulatory support for LHWs.

Tuberculin Skin Testing Among Healthcare Workers in the University of Malaya Medical Centre, Kuala Lumpur, Malaysia

2002 ◽  
Vol 23 (10) ◽  
pp. 584-590 ◽  
Author(s):  
Lian-HuatTan ◽  
Adeeba Kamarulzaman ◽  
Chong-Kin Iiam ◽  
Toong-Chow Lee
Keyword(s):  
Confidence Interval ◽  
Odds Ratio ◽  
Healthcare Workers ◽  
Skin Testing ◽  
Medical Centre ◽  
Tuberculin Skin Testing ◽  
Kuala Lumpur ◽  
Bacille Calmette Guerin ◽  
High Prevalence ◽  
The University

Objectives:To determine the occupational risk of Mycobacterium tuberculosis infection among healthcare workers (HCWs) and to examine the utility of tuberculin skin testing in a developing country with a high prevalence of bacille Calmette-Guerin vaccination.Design:Tuberculin skin test (TST) survey.Setting:A tertiary-care referral center and a teaching hospital in Kuala Lumpur, Malaysia.Participants:HCWs from medical, surgical, and orthopedic wards.Intervention:Tuberculin purified protein derivative RT-23 (State Serum Institute, Copenhagen, Denmark) was used for the TST (Mantoux method).Results:One hundred thirty-seven (52.1%) and 69 (26.2%) of the HCWs tested had indurations of 10 mm or greater and 15 mm or greater, respectively. Medical ward HCWs were at significantly higher risk of a positive TST reaction than were surgical or orthopedic ward HCWs (odds ratio, 2.18; 95% confidence interval, 1.33 to 3.57; P = .002 for TST positivity at 10 mm or greater) (odds ratio, 2.61; 95% confidence interval, 1.44 to 4.70; P = .002 for TST positivity at 15 mm or greater). A previous TST was a significant risk factor for a positive TST reaction at either 10 mm or greater or 15 mm or greater, but a duration of employment of more than 1 year and being a nurse were only significantly associated with a positive TST reaction at a cut-off point of 15 mm or greater.Conclusions:HCWs at the University of Malaya Medical Centre had an increased risk for M. tuberculosis infection that was significantly associated with the level of occupational tuberculosis exposure. A TST cut-off point of 15 mm or greater may correlate better with M. tuberculosis infection than a cut-off point of 10 mm or greater in settings with a high prevalence of bacille Calmette-Guerin vaccination (Infect Control Hosp Epidemiol 2002;23:584-590).

scholarly journals Tuberculosis in Healthcare Workers and Infection Control Measures at Primary Healthcare Facilities in South Africa

PLoS ONE ◽  
2013 ◽  
Vol 8 (10) ◽  
pp. e76272 ◽  
Author(s):  
Mareli M. Claassens ◽  
Cari van Schalkwyk ◽  
Elizabeth du Toit ◽  
Eline Roest ◽  
Carl J. Lombard ◽  
...  
Keyword(s):  
South Africa ◽  
Infection Control ◽  
Primary Healthcare ◽  
Healthcare Workers ◽  
Control Measures ◽  
Healthcare Facilities ◽  
Infection Control Measures
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