APIC and CDC survey of Mycobacterium tuberculosis isolation and control practices in hospitals caring for children Part 2: Environmental and administrative controls

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 environmental and administrative control recommendations. 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: Isolation rooms (IRs) generally conformed to recommended guideline s; 92% of respondents reported IRs with greater than or equal to 6 air chan ges per hour, 90% reported 1-pass air and negative pressure, and 89% report ed that IRs were private rooms. A sufficient number of inpatient IRs were r eported by 88%, but only 42% had IRs in outpatient areas, and 19% had IRs i n off-site clinics. Employee tuberculin skin-test programs were in place at 98% of facilities, but policies pertaining to implementation varied. Emplo yees' use of personal respirators increased at respondent hospitals from 19 91 to 1994, but as late as 1994, nearly one third still used surgical masks for high-risk procedures. Conclusions: Environmental and administrative controls used by respondent h ospitals largely conformed to published guidelines. Because definitive stud ies that quantify the risk of nosocomial M tuberculosis transmission in ped iatric settings have yet to be performed, pediatric facilities are required to have the same protections in place as do their adult counterparts.