TUBERCULOSIS SURVEILLANCE PRACTICES IN LONG-TERM-CARE INSTITUTIONS

OBJECTIVES: To identify the tuberculosis (TB) skin-testing practices o f long-term care facilities for the elderly in Toronto, Ontario. DESIG N: A telephone survey using a 25-item questionnaire. SETTING: Twenty-n ine nursing homes (NHs) and 26 Homes for the Aged (HFAs) in metropolit an Toronto. RESULTS: Thirty-one percent of facilities (17 of 55) had n o formal tuberculin skin-testing program, including 52% of NHs (15 of 29) versus 8% of HFAs (2 of 26; P=0.001). Ninety-two percent of HFAs ( 24 of 26), compared with 45% of NHs (13 of 29), obtained preadmission or admission skin-test status of residents (P=0.0005). Annual testing was performed at 46% of HFAs (12 of 26) and 27% of NHs (8 of 29; P=0.2 8). Of facilities that carried out any skin testing, 64% of HFAs (16 o f 25) versus 32% of NHs (6 of 19) measured induration to establish tes t positivity (P=0.068). Fifty-two percent of HFAs (13 of 25), compared with 21% of NHs (4 of 19), recorded the actual size of induration in the patient record (P=0.085). Only 28% of HFAs (7 of 25) and 21% of NH s (4 of 19) correctly defined a positive tuberculin skin test. CONCLUS IONS: TB surveillance practices in long-term care institutions in Toro nto are inadequate and often yield results that do not predict the ris k of infection and cannot be used to investigate outbreaks. Tuberculin skin-testing practices were better at HFAs, which are subject to prov incial legislation regarding TB surveillance, than at NHs, which are n ot subject to this legislation. Staff at HFAs and NHs require educatio n regarding tuberculin skin-testing policies and procedures