ARE US HOSPITALS MAKING PROGRESS IN IMPLEMENTING GUIDELINES FOR PREVENTION OF MYCOBACTERIUM-TUBERCULOSIS TRANSMISSION

Background: Outbreaks of tuberculosis (TB) in hospitals have occurred when the Centers for Disease Control and Prevention (CDC) guideline re commendations for preventing the transmission of Mycobacterium tubercu losis were not fully implemented. Objective: To determine whether US h ospitals are making progress in implementing the CDC guidelines for pr eventing TB. Methods: In 1992, we surveyed all public (city, county, V eterans Affairs, and primary medical school-affiliated) US hospitals ( n = 632) and 444 (20%) random samples of all private hospitals with 10 0 beds or more. In 1996, we resurveyed 136 random samples (50%) of all 1992 respondent hospitals with 6 or more TB admissions in 1991. Resul ts: Of the 1076 hospitals surveyed in 1992, 763 (71%) respondents retu rned a completed questionnaire. Among these, 536 (71%) of 755 reported having rooms chat met CDC criteria for acid-fast bacilli isolation, i e, negative air pressure, 6 or more air exchanges per hour, and air di rectly vented to the outside. The predominant respiratory protective d evice for health care workers was nonfitted surgical mask and attendin g physicians were infrequently (50%) included in tuberculin skin-testi ng programs. In the 1996 resurvey, 103 (76%) of 136 respondents return ed a completed questionnaire. Of these, 99 (96%) reported having rooms that met CDC criteria for acid-fast bacilli isolation. The N95 respir atory protective devices were predominantly used by health care worker s, and attending physicians were increasingly (69%) included in the ho spitals' tuberculin skin-testing programs. Conclusions: Most US hospit als are making progress in the implementation of CDC guidelines for pr eventing the transmission of M tuberculosis.