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.

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.

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).

Tuberculosis: Infection Control/Exposure Control Issues for Oral Healthcare Workers

2008 ◽  
Vol 9 (1) ◽  
pp. 1-13 ◽  
Author(s):  
Geza T. Terezhalmy ◽  
Nuala B. Porteous
Keyword(s):  
Infection Control ◽  
Healthcare Workers ◽  
Healthcare Setting ◽  
Essential Elements ◽  
Exposure Control ◽  
Standard Precautions ◽  
Control Plan ◽  
Healthcare Settings ◽  
Tuberculosis Infection Control ◽  
Tb Infection Control

Abstract Aim The aim is to present the essential elements of an infection control/exposure control plan for the oral healthcare setting with emphasis on tuberculosis (TB). Methods and Materials A comprehensive review of the literature was conducted with special emphasis on TB infection-control issues in the oral healthcare setting. Results Currently available knowledge related to TB infection-control issues is supported by data derived from well-conducted trials or extensive controlled observations. In the absence of supportive data the information is supported with the best-informed, most authoritative opinion available. Conclusion Essential elements of an effective TB infection-control plan include a three-level hierarchy of administrative, environmental, and respiratory-protection controls. Clinical Significance Standard precautions provide the fabric for strategies to prevent or reduce the risk of exposure to bloodborne pathogens and other potentially infectious material. However, standard precautions are inadequate to prevent the spread of organisms through droplet nuclei 1-5 micron in diameter and additional measures are necessary to prevent the spread of Mycobacterium tuberculosis. Oral healthcare settings have been identified as outpatient settings in which patients with suspected or confirmed infectious TB disease are expected to be encountered. Therefore, oral healthcare settings must have a written TB infection-control program. Citation Porteous NB, Terezhalmy GT. Tuberculosis: Infection Control/Exposure Control Issues for Oral Healthcare Workers. J Contemp Dent Pract 2008 January; (9)1:001-013.

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.

The Booster Phenomenon in 2-Step Tuberculin Skin Testing in Hemodialysis Patients

GEGET ◽  
2004 ◽  
Vol 4 (1) ◽  
pp. 61-69
Author(s):  
Bahia Mostafa ◽  
Mona Elattar ◽  
Rasha Gamal El-Din ◽  
Hossam Masoud
Keyword(s):  
Skin Testing ◽  
Hemodialysis Patients ◽  
Tuberculin Skin Testing

scholarly journals Simulation of risk of tuberculosis infection in healthcare workers in hospitals of an intermediate incidence country

2014 ◽  
Vol 143 (12) ◽  
pp. 2639-2647 ◽  
Author(s):  
J. OCHOA ◽  
D. HINCAPIÉ-PALACIO ◽  
H. SEPÚLVEDA ◽  
D. RUIZ ◽  
A. MOLINA ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Skin Testing ◽  
Risk Groups ◽  
Tuberculosis Infection ◽  
Risk Level ◽  
Infection Prevalence ◽  
Tuberculin Skin Testing ◽  
Interferon Gamma Release Assays ◽  
Hospital Infection Control ◽  
Assessment Approach

SUMMARYWe simulated the frequency of tuberculosis infection in healthcare workers in order to classify the risk of TB transmission for nine hospitals in Medellín, Colombia. We used a risk assessment approach to estimate the average number of infections in three risk groups of a cohort of 1082 workers exposed to potentially infectious patients over 10- and 20-day periods. The risk level of the hospitals was classified according to TB prevalence: two of the hospitals were ranked as being of very high priority, six as high priority and one as low priority. Consistent results were obtained when the simulation was validated in two hospitals by studying 408 healthcare workers using interferon gamma release assays and tuberculin skin testing. The latent infection prevalence using laboratory tests was 41% [95% confidence interval (CI) 34·3–47·7] and 44% (95% CI 36·4–51·0) in those hospitals, and in the simulation, it was 40·7% (95% CI 32·3–49·0) and 36% (95% CI 27·9–44·0), respectively. Simulation of risk may be useful as a tool to classify local and regional hospitals according to their risk of nosocomial TB transmission, and to facilitate the design of hospital infection control plans.

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