APIC and CDC survey of Mycobacterium tuberculosis isolation and control practices in hospitals caring for children Part 1: Patient and family isolation policies and procedures

Background: The 1994 Centers for Disease Control and Prevention draft Guide lines for Preventing the Transmission of Mycobacterium tuberculosis in Heal th-Care Facilities did not exempt pediatric facilities from instituting con trols to prevent nosocomial tuberculosis (TB) transmission. Many researcher s contend that TB disease in children does not require such rigid controls. We surveyed acute-care pediatric facilities in the United States to determ ine adherence to patient and family isolation policies and procedures. Methods: The study included 4 mailings of a survey to infection control pro fessionals at 284 US children's hospitals and adult acute-care hospitals wi th >30 pediatric beds. Results: The overall response rate was 69%. Only 41% of respondents reporte d having a written TB policy specifically designed for pediatric patients. Whereas 98% of respondents isolated pediatric patients with confirmed pulmo nary TB, only 69% reported isolation of patients with miliary TB, and 79% r eported isolation of patients with positive gastric aspirates. TB isolation policies for adult visitors were in place at 69% of hospitals, and 50% of hospitals evaluated adults for TB as part of the child's TB treatment plan. A median of 3 contact investigations occurred at each of 47% of respondent hospitals in the preceding 5 years. Conclusions: Isolation and infection control policies for children with pul monary TB largely conformed to published guidelines but varied for children with nonpulmonary TB. Because the greatest risk of nosocomial TB transmiss ion in pediatric facilities comes from adults with TB, a rapid TB screening process for parents and adult contacts accompanying affected children shou ld be instituted at facilities caring for children.