Abstract 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) References 1. Reider HL, Cauthern GM, Kelly GD, Block AB, Snider DE. Tuberculosis in the United States. JAMA . 1989;262:385-389.Crossref 2. Centers for Disease Control. Guidelines for preventing the transmission of tuberculosis in health care settings with special focus on HIV related issues. MMWR Morb Mortal Wkly Rep . 1990;39( (RR-17) ):1-29. 3. Le CT. Cost-effectiveness of the two step skin test for tuberculosis screening in a community hospital. Infect Control . 1984;5:570-572. 4. Atuk NO, Hunt EH. Serial tuberculin testing and isoniazid therapy on general hospital employees. JAMA . 1971;218:1795-1798.Crossref 5. Bryan CS, McVicker S. Tuberculosis in the community hospital: lessons from a single year. J Sci Med Assoc . 1977;73:267-273. 6. Valenti WM, Andrews BA, Presley BA, Reifler CB. Absence of booster phenomenon in serial tuberculin testing. Am Rev Respir Dis . 1982;125:323-325. 7. Ruben F, Norden C, Schuster N. Analysis of a community hospital employee TB screening program 31 months after its inception. Am Rev Respir Dis . 1977; 115:23-28.
Archives of Internal Medicine – American Medical Association
Published: Aug 7, 1995