CONTROL OF NOSOCOMIAL TRANSMISSION OF MULTIDRUG-RESISTANT MYCOBACTERIUM-TUBERCULOSIS AMONG HEALTH-CARE WORKERS AND HIV-INFECTED PATIENTS

From 1988 to 1990, an outbreak of multidrug-resistant tuberculosis (MD R-TB) among patients, and an increased number of tuberculin-skin-test conversions among healthcare workers, occurred on the HIV ward of Jack son Memorial Hospital, Miami, Florida, USA. Measures similar to those subsequently recommended in the 1990 Centers for Disease Control and P revention guidelines were implemented on the HIV ward by June, 1990, a nd in September, 1992, we evaluated the efficacy of these control meas ures. Among MDR-TB patients and healthcare workers with tuberculin-ski n-test conversions on the HIV ward, we looked for evidence of exposure to HIV ward MDR-TB patients positive for acid-fast bacilli in sputum during initial January-May, 1990) and follow-up (June, 1990-June, 1992 ) periods. Exposure before implementation of control measures to an in fectious MDR-TB patient on the HIV ward was recorded in 12 of 15 (80%) MDR-TB patients during the initial period and 5 of 11(45%) MDR-TB pat ients during follow-up. After implementation of control measures, no e pisodes of MDR-TB could be traced to contact with infectious MDR-TB pa tients on the HIV ward. Skin-test conversions among workers on the HIV ward declined from 7 of 25 (28%) during the initial period to 3 of 17 (18%) in the early (June, 1990-February, 1998) and 0 of 23 in the lat e (March, 1991-June, 1992) follow-up periods (p<0.01). Skin-test conve rsions among healthcare workers were not associated with increased exp osure to MDR-TB patients, and were not significantly higher among work ers on the HIV ward than on a control ward without tuberculosis patien ts (3/27 vs 0/16). These data demonstrate that implementation of measu res similar to the Centers for Disease Control and Prevention 1990 tub erculosis-control guidelines were effective in halting transmission of MDR-TB to healthcare workers and HIV-infected patients.