VARIED APPROACHES TO TUBERCULOSIS-CONTROL IN A MULTIHOSPITAL SYSTEM

OBjECTIVES: To document the actual tuberculosis (TB) control policies and procedures in a nonoutbreak setting in a variety of hospitals. To determine if any particular practices are linked to higher rates of em ployee tuberculin skin-test conversion. DESIGN: Survey of hospital occ upational health and infection control practitioners for the year 1994 regarding hospital TB policies. Review of hospital records to verify the number of patients with TB at each hospital and to verify the numb er of employees with positive tuberculin skin tests. Smoke-stick testi ng of negative-pressure ventilation rooms. SETTING: A 13-hospital heal th system in the Midwest. RESULTS: Hospitals ranged in size from 40 to 1,208 beds (median 220) and employed 150 to 6,500 workers (median 875 ). There were seven rural and six urban centers, including four teachi ng hospitals. All 13 hospitals had TB control plans, and all performed annual tuberculin skin testing on employees. Annual skin-test positiv ity rates ranged from 0% to 1.0% (median 0.3%). Negative-pressure vent ilation rooms were available in 11 hospitals. The percentage of negati ve-pressure rooms with effective negative pressure ranged from 44% to 100% (median 95%). Three of the 13 hospitals used high-efficiency part iculate air (HEPA) masks as primary personal respiratory protection, a nd 8 used dust-mist or dust-mist-fume masks. We found no relation betw een the type of face mask used, number of functional negative-pressure rooms, or hospital TB risk category, and employee skin-test conversio n rates. CONCLUSIONS: Considerable variation existed in the TB control policies and procedures between hospitals, but employee TB skin-test conversion rates were low in all settings (Infect Control Hosp Epidemi ol 1997;18:548-553).