ASSESSING THE RELATIVE IMPORTANCE OF THE COMPONENTS OF AN OCCUPATIONAL TUBERCULOSIS-CONTROL PROGRAM

Hospital-based occupational tuberculosis (TB) control programs have fo ur basic components: rapid detection of TB disease in presenting patie nts; use of environmental controls, including personal respiratory pro tection; periodic tuberculin skin testing; and administration of proph ylactic antibiotic therapy to newly infected employees. This article a ssesses which component is the most important in reducing TB disease r isk among health care workers. A quantitative framework for estimating disease risk is developed and two important results are described, Fi rst, the rapid identification of TB disease in presenting patients is the most important element in the overall program, Second once TB dise ase has been identified, the use of highly efficient environmental con trols (which include respiratory protection) becomes the most importan t element; these controls are especially important for procedures such as bronchoscopy and autopsy, which can aerosolize large numbers of vi able Mycobacterium tuberculosis bacilli.