TUBERCULOSIS INFECTION-CONTROL PRACTICES IN UNITED-STATES EMERGENCY DEPARTMENTS

Study objective: To determine the frequency with which patients with s uspected tuberculosis (TB) or TB risk factors present to US emergency departments and to describe current ED TB infection-control facilities and practices. Design: Mailed survey of a sample of EDs in US acute c are facilities. Participants: A random sample (n=446) of subjects who responded to a 1992 survey of all US municipal, Veterans Affairs, and university-affiliated hospitals and a 20% random sample of all private hospitals with more than 100 beds conducted by the Centers for Diseas e Control and Prevention (CDC). Results: We collected data on patient demographics and general ED characteristics, TB isolation facilities a nd policies, and employee tuberculin skin-testing policies and results . Of 446 facilities surveyed, 305 surveys (68.4%) were returned. The p roportions of facilities reporting that patients suspected of having T B are seen daily, weekly, monthly, and less frequently were, respectiv ely, 12.6%, 17.2%, 23.3%, and 46.9%. The proportion of EDs in which in digent patients are cared for on a daily basis was 89%; the homeless, 57.5%; the HIV-infected, 35.9%; IV drug users, 45.4%; and recent immig rants, 30%. Written criteria for isolation of patients with suspected TB at triage or in the ED were in place in 56% and 76% of facilities, respectively. TB isolation rooms fulfilling CDC guidelines were availa ble in triage or waiting areas in 1.7% of facilities and in 19.6% of E Ds. Air venting directly outside, high-efficiency particulate air filt ration of recirculated air, and UV germicidal lights were used in 21%, 77%, and 8% of general patient care areas of EDs, respectively At lea st one ED employee had shown tuberculin skin test conversion in 16.1% of EDs in 1991; this figure was 26.9% in 1992. Conclusion: Patients wi th TB or at risk for TB are often treated in US EDs, and the risk for transmission of TB in this set; ting appears to be increasing. Prolong ed waiting times and lack of infection-control facilities in EDs may c ontribute to this problem. Consideration should be given to implementa tion of policies and facilities recommended by the CDC.