Hostname: page-component-8448b6f56d-c4f8m Total loading time: 0 Render date: 2024-04-23T15:25:35.683Z Has data issue: false hasContentIssue false

Rates of Tuberculosis Infection in Healthcare Workers Providing Services to HIV-Infected Populations

Published online by Cambridge University Press:  31 March 2016

Karen Zahnow
Affiliation:
Division of Infectious Diseases, Veterans' Affairs Medical Center, Washington, DC
John P. Matts
Affiliation:
Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
David Hillman
Affiliation:
Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
Elizabeth Finley
Affiliation:
Division of Infectious Diseases, Veterans' Affairs Medical Center, Washington, DC
Lawrence S. Brown Jr
Affiliation:
Addiction Research and Treatment Corporation, Harlem Hospital, Columbia University, New York City
Ramon A. Torres
Affiliation:
Clinical Directors' Network of Region II and St Vincent's Hospital and Medical Center of New York, New York City
Jerome Ernst
Affiliation:
Bronx-Lebanon Hospital Center, Bronx, New York
Wafaa El-Sadr
Affiliation:
Division of Infectious Diseases, Harlem Hospital Center, New York City, New York
George Perez
Affiliation:
New Jersey Community Research Initiative and Atlantic City Medical Center, New Jersey
Carol Webster
Affiliation:
Richmond AIDS Consortium, Richmond, Virginia
Beverly Barber
Affiliation:
Denver CPCRA, Denver Public Health Department, Denver, Colorado
Fred M. Gordin*
Affiliation:
Division of Infectious Diseases, Veterans' Affairs Medical Center, Washington, DC
*
Infectious Diseases (2C South), VA Medical Center, 50 Irving St NW, Washington, DC 20422

Abstract

OBJECTIVE:

To assess the prevalence of tuberculosis (TB) or a positive skin test in healthcare workers (HCWs) providing services to human immunodeficiency virus (HIV)-infected individuals and to determine prospectively the incidence of new infections in this population.

DESIGN:

This prospective cohort study enrolled 1,014 HCWs working with HIV-infected populations from 10 metropolitan areas. Purified protein derivative (PPD) tuberculin skin tests were placed at baseline and every 6 months afterwards on those without a history of TB or a positive PPD. Demographic, occupational, and TB exposure data also were collected.

SETTING:

Outpatient clinics, hospitals, private practice offices, and drug treatment programs providing HIV-related healthcare and research programs.

PARTICIPANTS:

A voluntary sample of staff and volunteers from 16 Community Programs for Clinical Research on AIDS units.

RESULTS:

Factors related to prior TB or a positive skin test at baseline included being foreign-born, increased length of time in health care, living in New York City, or previous bacille Calmette-Guerín vaccination. The rate of PPD conversion was 1.8 per 100 person years of follow-up. No independent relation was found between the amount or type of contact with HIV-infected populations and the risk of TB infection.

CONCLUSION:

These data provide some reassurance that caring for HIV-infected patients is not related to an increased rate of TB infection among HCWs in these settings.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1998

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Sepkowitz, KA. Tuberculosis and the health care worker: a historical perspective. Ann Intern Med 1994;120:7179.CrossRefGoogle ScholarPubMed
2. Menzies, D, Fanning, A, Yuan, L, Fitzgerald, M. Tuberculosis among health care workers. N Engl J Med 1995;332:9297.CrossRefGoogle ScholarPubMed
3. Centers for Disease Control. Transmission of multidrug-resistant tuberculosis among immunocompromised persons in a correctional system— New York, 1991. MMWR 1992;41:507509.Google Scholar
4. Beck-Sague, C, Dooley, SW, Hutton, MD, Otten, J, Breeden, A, Crawford, JT, et al. Hospital outbreak of multi-drug resistant Mycobacterium tuberculosis infections. JAMA 1992;268:12801286.CrossRefGoogle Scholar
5. Pearson, ML, Jereb, JA, Frieden, TR, Crawford, JT, Davis, BJ, Dooley, SW, et al. Nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis . Ann Intern Med 1992;117:191196.CrossRefGoogle ScholarPubMed
6. Dooley, SW, Villarino, ME, Lawrence, M, Salinas, L, Amil, S, Rullan, JV, et al. Nosocomial transmission of tuberculosis in a hospital unit for HIV- infected patients. JAMA 1992;267:26322635.CrossRefGoogle Scholar
7. DiPerri, G, Cadeo, GP, Castelli, F, Micciolo, R, Basseti, S, Rubini, F, et al. Transmission of HIV-associated tuberculosis to healthcare workers. Infect Control Hosp Epidemiol 1993;14:6772.CrossRefGoogle Scholar
8. Barnes, PF, Bloch, AB, Davidson, PT, Snider, DE. Tuberculosis in patients with human immunodeficiency virus infection. N Engl J Med 1991;324:16441650.CrossRefGoogle ScholarPubMed
9. Wurtz, R, Fernandez, J, Jovanovic, B. Real and apparent tuberculin skin test conversions in a group of medical students. Infect Control Hosp Epidemiol 1994;15:516519.CrossRefGoogle Scholar
10. Griffith, DE, Hardeman, JL, Zhang, Y, Wallace, RJ, Mazurek, GH. Tuberculosis outbreak among healthcare workers in a community hospital. Am J Respir Crit Care Med 1995;152:808811.CrossRefGoogle Scholar
11. Blumberg, HM, Watkins, DL, Berschling, JD, Antle, A, Moore, P, White, N, et al. Preventing the nosocomial transmission of tuberculosis. Ann Intern Med 1995;122:658663.CrossRefGoogle ScholarPubMed
12. American Thoracic Society. Diagnostic standards and classification of tuberculosis. Am Rev Respir Dis 1990;142:725735.CrossRefGoogle Scholar
13. Breiman, L, Friedman, JH, Olshen, RA, Stone, CJ. Classification and Regression Trees. Belmont, CA: Wadsworth; 1984.Google Scholar
14. Fischl, MA, Uttamchandani, RB, Daikos, GL, Poblete, RB, Moreno, JN, Reyes, RR, et al. An outbreak of tuberculosis caused by multiple-drug-resistant tubercle bacilli among patients with HIV infection. Ann Intern Med 1992;117:177183.CrossRefGoogle ScholarPubMed
15. Edlin, BR, Tokars, JI, Grieco, MH, Crawford, JT, Williams, J, Sordillo, EM, et al. An outbreak of multidrug-resistant tuberculosis among hospitalized patients with the acquired immunodeficiency syndrome. N Engl J Med 1992;326:15141521.CrossRefGoogle ScholarPubMed
16. Kramer, F, Modilevsky, T, Waliany, AR, Leedom, JM, Barnes, PF. Delayed diagnosis of tuberculosis in patients with human immunodeficiency virus infection. Am J Med 1990;89:451456.CrossRefGoogle ScholarPubMed
17. Hopewell, PC. Impact of human immunodeficiency virus infection on the epidemiology, clinical features, management, and control of tuberculosis. Clin Infect Dis 1992;15:540547.CrossRefGoogle ScholarPubMed
18. Centers for Disease Control. Nosocomial transmission of multidrug-resistant tuberculosis among HIV-infected persons—Florida and New York, 1988-1991. MMWR 1991;40:585591.Google Scholar
19. Cantwell, MF, Snider, DE, Cauthen, GM, Onorato, IM. Epidemiology of tuberculosis in the United States, 1985 through 1992. JAMA 1994;272:535539.CrossRefGoogle ScholarPubMed
20. Sepkowitz, KA. AIDS, tuberculosis, and the health care worker. Clin Infect Dis 1995; 20:232242.CrossRefGoogle ScholarPubMed
21. McKenna, MT, Hutton, M, Cauthen, G, Onorato, IM. The association between occupation and tuberculosis: a population-based survey. Am J Respir Crit Care Med 1996;154:587593.CrossRefGoogle ScholarPubMed
22. Bailey, TC, Fraser, VJ, Spitznagel, EL, Dunagan, WC. Risk factors for a positive tuberculin skin test among employees of an urban, Midwestern teaching hospital. Ann Intern Med 1995;122:580585.CrossRefGoogle ScholarPubMed
23. Sepkowitz, KA, Fella, P, Rivera, P, Villa, N, DeHovitz, J. Prevalence of PPD positivity among new employees at a hospital in New York City. Infect Control Hosp Epidemiol 1995;16:344347.CrossRefGoogle Scholar
24. Louther, J, Rivera, P, Feldman, J, Villa, N, DeHovitz, J, Sepkowitz, KA. Risk of tuberculin conversion according to occupation among health care workers at a New York City hospital. Am J Respir Crit Care Med 1997;156:201205.CrossRefGoogle Scholar
25. Fridkin, SK, Manangan, L, Bolyard, E, Jarvis, WR. SHEA-CDC TB survey, part I: status of TB infection control programs at member hospitals, 1989-1992. Infect Control Hosp Epidemiol 1995;16:129134.CrossRefGoogle ScholarPubMed
26. Panlilio, A, Burwen, D, the TB Infection Surveillance Project, Centers for Disease Control and Prevention. Tuberculosis (TB) skin testing surveillance of health care workers (HCWs). Presented at the Sixth Annual Meeting of the Society for Healthcare Epidemiology of America; 04 21-23, 1996; Washington, DC. Abstract 12.Google Scholar
27. Fridkin, SK, Manangan, L, Bolyard, E, and Jarvis, WR. SHEA-CDC TB survey, part II: efficacy of TB infection control programs at member hospitals, 1992. Infect Control Hosp Epidemiol 1995;16:135140.CrossRefGoogle ScholarPubMed
28. Liss, GM, Khan, R, Koven, E, Simor, AE. Tuberculosis infection among staff at a Canadian community hospital. Infect Control Hosp Epidemiol 1996;17:2935.CrossRefGoogle Scholar
29. Maloney, SA, Pearson, ML, Gordon, MT, Del Castillo, R, Boyle, JF, Jarvis, WR. Efficacy of control measures in preventing nosocomial transmission of multidrug-resistant tuberculosis to patients and health care workers. Ann Intern Med 1995;122:9095.CrossRefGoogle ScholarPubMed
30. Castro, KG, Dooley, SW. Mycobacterium tuberculosis transmission in healthcare settings: is it influenced by coinfection with human immunodeficiency virus? Infect Control Hosp Epidemiol 1993;14:6566.CrossRefGoogle ScholarPubMed
31. American Thoracic Society. Control of tuberculosis in the United States. Am Rev Respir Dis 1992;146:16231633.CrossRefGoogle Scholar
32. Centers for Disease Control. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care facilities, 1994. MMWR 1994;43:RR13.Google Scholar