COSTS OF IMPLEMENTING A TUBERCULOSIS-CONTROL PLAN - A COMPLETE EDUCATION MODULE THAT USES A TRAIN-THE-TRAINER CONCEPT

Background: Tuberculosis once was thought to be nearly eradicated, but there was a 13% increase in cases of tuberculosis between 1985 and 19 93, although decreases were observed in both 1994 and 1995. To reduce spread of this disease, hearth care workers must be familiar with tube rculosis, its signs, symptoms, and modes of transmission. In October 1 994 the Centers for Disease Control and Prevention issued ''Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Heal th Care Facilities.'' The combination of persistently high tuberculosi s case rates, the development of multidrug-resistant tuberculosis, the new Centers for Disease Control and Prevention recommendations, and O ccupational Safety and Health Administration enforcement has mandated large-scale training in health care facilities. Methods: A tuberculosi s control plan was developed and the train-the-trainer concept was sel ected after review of the hospital's tuberculosis risk assessment, sta ff members requiring Graining, and available tracking staff. The train ing program that was developed included tuberculosis pathology and tra nsmission, national and local epidemiology placement and evaluation of skin tests, and an algorithm to assist in determining when isolation is indicated. Results: One hundred forty-six trainers were trained in 4 days. During the next quarter, 66% (1989/3000) of staff members requ iring instruction were trained. The total cost. involved in developmen t and training was approximately $26,000 and involved 1600 person-hour s. Conclusion: Tuberculosis training should be directed toward high-ri sk areas, including intensive care units, emergency departments, and a cute medicine wards. Large-scale training is time-consuming and expens ive. Evaluation remains difficult. To facilitate compliance, pretest a nd posttest results should be provided, linked to Occupational Safety and Health Administration compliance and quality indicators for the ho spital.