EVALUATION OF INFECTION-CONTROL PARAMETERS ACCORDING TO THE 1994 CENTERS-FOR-DISEASE-CONTROL AND PREVENTION TUBERCULOSIS GUIDELINES - A 2-YEAR EXPERIENCE

Background: Because of classification as a high-risk institution for p otential Mycobacterium tuberculosis exposure and an employee purified protein derivative conversion rate of 2.7%, a large university-affilia ted county hospital enhanced administrative and engineering controls, as recommended by its tuberculosis task force in early 1994. Methods: For 1994 and 1995 the medical records of all patients with culture-con firmed M. tuberculosis were reviewed according to the 1994 Centers for Disease Control and Prevention guidelines for case surveillance and r isk assessment (infection control parameters). The chi(2)-test was use d to compare 1994 and 1995 infection control parameters for statistica l significance (p less than or equal to 0.05). Results: In 1994 and 19 95 there were 253 patients with tuberculosis, 85% of whom (214/253) ha d pulmonary-site tuberculosis. The ''representative'' patient with pul monary tuberculosis was profiled, along with institution-specific surv eillance data on diagnostics, medication regimens, and airborne isolat ion practices. Between 1994 and 1995 there was a trend toward increase d numbers of homeless patients with tuberculosis, from 8.2% to 17% (p = 0.07). Decreases in the numbers of HIV seropositive patients with tu berculosis from 35% in 1994 to 24% in 1995 (p = 0.2) and of jailed pat ients with tuberculosis from 9.8% to 5% (p = 0.5) were not significant . Drug-resistance patterns increased from 13% to 24%, with borderline significance (p = 0.06). The employee purified protein derivative test ing compliance rate increased from 49% in 1994 to 74% in 1995, with th e purified protein derivative conversion rate also increasing from 2.7 % to 3.5%. Conclusion: The infection control parameter data were benef icial in identification of institution-specific risk factors for our p opulation with tuberculosis. Although labor-intensive, the annual tube rculosis reports supported requests for administrative and engineering controls; however, efficacy of the 1994 tuberculosis control plan was difficult to assess from purified protein derivative conversion rates alone, because the testing compliance rate also increased.