LOW-RISK FOR TUBERCULOSIS IN A REGIONAL PEDIATRIC HOSPITAL - 9-YEAR STUDY OF COMMUNITY RATES AND THE MANDATORY EMPLOYEE TUBERCULIN SKIN-TEST PROGRAM

OBJECTIVE: To assess the risk of Mycobacterium tuberculosis infection and disease among patients and workers in a regional pediatric hospita l. DESIGN: Descriptive epidemiological study of the mandatory tubercul in skin testing program of hospital employees at hire and during annua l reevaluation, pediatric patients with tuberculosis (TB), efficacy of hospital infection control measures, and community rates of TB. SETTI NG: 361-bed, university, pediatric hospital serving Cincinnati (1.7 mi llion population). RESULTS: During 1986 through 1994, 2,275 to 4,356 e mployees were compliant with Mantoux skin testing and screening each y ear. This represented >97% of the population who were eligible for scr eening. The cumulative rate of M tuberculosis infection from a previou s positive tuberculin skin test was 10% to 12% per year during 1986 th rough 1994. Among new Mantoux skin-test converters in employees at ann ual reevaluation, the risk of TB infection was 0.3% in 1993 and 1994. There were no active cases of TB identified during new employee screen ing or annual reevaluation. Of 62 new Mantoux skin-test converters in 9 years, 23% were foreign-born, 13% were Asian, 23% were African Ameri can, 11% received the bacillus of Calmette-Guerin vaccine, and 60% had direct patient care or indirect patient contact A cluster of five con verters occurred in a department with no patient care or contact. Mant oux conversion rates were 1.9 per 1,000 employee patient-care or conta ct-years and 2.2 per 1,000 employee non-patient-contact years. Twenty pediatric patients with active TB were identified during 1991 to 1994, with less than or equal to 6 cases per year, placing this hospital in the low-risk category for M tuberculosis disease. Three children with pulmonary TB were admitted without immediate respiratory isolation, p ossibly exposing 9 patients and 42 employees; none converted their Man toux skin tests on retesting. Rates of active TB in Cincinnati were st able during the period leg, 8/100,000 population in 1994). CONCLUSIONS : Despite intense active surveillance among thousands of hospital empl oyees with >97% annual compliance, tuberculin conversion rates were lo w, and no cases of active TB were identified during 9 years of follow- up. There was no evidence of transmission of M tuberculosis from infec ted patients to employees during uncontrolled exposures. Rates of TB i n the community were low. These data suggest that rigorous application of the Centers for Disease Control and Prevention guidelines and Occu pation Safety and Health Administration regulations for preventing nos ocomial TB in pediatric hospitals may be excessive and costly. Special provisions should be made for pediatric hospitals with a proven low r isk of transmission of M tuberculosis (Infect Control Hosp Epidemiol 1 998;19:168-174).