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Risk of Tuberculous Infection Among Healthcare Workers in a Tertiary-Care Hospital in Ankara, Turkey

Published online by Cambridge University Press:  02 January 2015

Ramazan Keskiner
Affiliation:
Infectious Disease Department, Ankara Numume Education and Research Hospital, Ankara, Turkey
Önder Ergönül*
Affiliation:
Infectious Disease Department, Ankara Numume Education and Research Hospital, Ankara, Turkey
Ziya Demiroglu
Affiliation:
Infectious Disease Department, Ankara Numume Education and Research Hospital, Ankara, Turkey
Sebnem Eren
Affiliation:
Infectious Disease Department, Ankara Numume Education and Research Hospital, Ankara, Turkey
Nurcan Baykam
Affiliation:
Infectious Disease Department, Ankara Numume Education and Research Hospital, Ankara, Turkey
Basak Dokuzoguz
Affiliation:
Infectious Disease Department, Ankara Numume Education and Research Hospital, Ankara, Turkey
*
Ankara Numune Education andResearch Hospital, Infectious Diseases Department, Ankara, Turkey

Abstract

Objective:

To determine risk factors for tuberculin skin test (TST) positivity among healthcare workers (HCWs).

Design:

Two-step TST was performed in 2002.

Setting:

Tertiary-care hospital in Ankara, Turkey.

Participants:

A sample of 491 hospital HCWs were included. Information related to demographics, profession, work duration, department, and individual and family history of tuberculosis (TB) was obtained by a structured questionnaire.

Results:

Four hundred eight (83%) had two-step TST positivity. On multivariate analysis, male physicians (relative risk [RR], 1.5; 95% confidence interval [CI95], 1.23–1.69; P = .001), nurses (RR, 1.5; CI95, 1.29–1.66; P = .005), radiology technicians (RR, 1.7; CI95, 1.35–1.73; P = .002), laboratory technicians (RR, 1.6; CI95, 1.3–1.74; P = .007), and male housekeepers (RR, 1.6; CI95, 1.38–1.7; P < .001) had a higher risk than did female physicians. Among laboratory technicians, radiology technicians had the highest TST positivity (85%). HCWs working for less than 1 year (RR, 0.8; CI95, 0.72–0.98; P = .027) had a lower risk of infection. The HCWs having bacille Calmette–Guérin vaccination (RR, 1.12; CI95, 1.08–1.45) had higher TST positivity.

Conclusion:

Male physicians, nurses, and laboratory technicians had increased risk of Mycobacterium tuberculosis infection in this setting, but community exposure likely accounted for most infections.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

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References

1.Sepkowitz, KA. Tuberculosis and the health care worker: a historical perspective. Ann Intern Med 1994;120:719Google ScholarPubMed
2.Centers for Disease Control. Nosocomial transmission of multidrug-resistant tuberculosis to HCWs and HIV-infected patients in an urban hospital: Florida. MMWR 1990;39:718722.Google Scholar
3.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
4.Snider, DE JrDooley, SW. Nosocomial tuberculosis in the AIDS era with an emphasis on multidrug-resistant disease. Heart Lung 1993;22:365369.Google Scholar
5.Jarvis, WR. Nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis. Res Microbiol 1993;144:117122.Google Scholar
6.Jereb, JA, Klevens, RM, Privett, TD, et al.Tuberculosis in health care workers at a hospital with an outbreak of MDR Mycobacterium tuberculosis. Arch Intern Med 1995;155:854859.CrossRefGoogle Scholar
7.Ikeda, RM, Birkhead, GS, DiFerdinando, GR, et al.Nosocomial tuberculosis: an outbreak of a strain resistant to seven drugs. Infect Control Hosp Epidemiol 1995;16:152159.Google Scholar
8.Zaza, S, Blumberg, HM, Beck-Sague, C, et al.Nosocomial transmission of Mycobacterium tuberculosis: role of health care workers in outbreak propagation. J Infect Dis 1995;172:15421549.Google Scholar
9.World Health Organization. Guideline for the Prevention of Tuberculosis in Health Care Facilities in Resource-Limited Settings. Geneva: World Health Organization; 1999.Google Scholar
10.Tan, LH, Kamarulzaman, A, Liam, CK, Lee, TC. Tuberculin skin testing among healthcare workers in the University of Malaya Medical Centre, Kuala Lumpur, Malaysia. Infect Control Hosp Epidemiol 2002;23:584590.Google ScholarPubMed
11.The Republic of Turkey Ministry of Health. Statistics of Tuberculosis in Turkey, 2001. Ankara, Turkey: The Republic of Turkey Ministry of Health; 2001. Available at www.saglik.gov.tr/istatistik.htm. Accessed on January 1, 2003.Google Scholar
12.Cuhadaroglu, C, Erelel, M, Tabak, L, Kilicaslan, Z. Increased risk of tuberculosis in health care workers: a retrospective survey at a teaching hospital in Istanbul, Turkey. Biomedcentral Infectious Disease 2002;2:14.Google Scholar
13.Kilinc, O, Ucan, ES, Cakan, MD, et al.Risk of tuberculosis among health care workers: can tuberculosis be considered as an occupational disease? Respir Med 2002;96:506510.Google Scholar
14.Centers for Disease Control and Prevention. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care facilities, 1994. MMWR 1994;43(RR-13):1132.Google Scholar
15.Zhang, J, Yu, KF. What's the relative risk? JAMA 1998;280:16901691.Google Scholar
16.Uçan ES ve ark. Evaluation of tuberculin skin test. Journal of Thorax 2000;1:2529.Google Scholar
17.Thompson, NJ, Glassroth, JL, Snider, DE, Farer, LS. The booster phenomenon in serial tuberculin skin testing. Am Rev Respir Dis 1979;119:587597.Google Scholar
18.Sepkowitz, KA, Feldman, J, Louther, J, Rivera, P, Villa, N, DeHovitz, J. Benefit of two-step PPD testing of new employees at a New York City hospital. Am J Infect Control 1997;25:283286.Google Scholar
19.Menzies, RI, Vissandje, B, Rocher, I, St. Germain, Y. The booster effect in two-step tuberculin testing among young adults in Montreal. Ann Intern Med 1994;120:190198.Google Scholar
20.Hallak, KM, Schenk, M, Neale, AV. Evaluation of the two-step tuberculin skin test in health care workers at an inner-city medical center. J Occup Environ Med 1999;41:393396.CrossRefGoogle ScholarPubMed
21.Sherman, RA, Shimoda, KJ. Tuberculosis tracking: determining the frequency of the booster effect in patients and staff. Am J Infect Control 2001;29:712.Google Scholar
22.Larsen, NM, Biddle, CL, Sotir, MJ, White, N, Parrott, P, Blumberg, HM. Risk of tuberculin skin test conversion among health care workers: occupational versus community exposure and infection. Clin Infect Dis 2002;35:796801.Google Scholar
23.Plitt, SS, Soskolne, CL, Fanning, EA, Newman, SC. Prevalence and determinants of tuberculin reactivity among physicians in Edmonton, Canada: 1996-1997. Int J Epidemiol 2001;30:10221028.Google Scholar
24.Warren, DK, Foley, KM, Polish, LB, Seiler, SM, Fraser, VJ. Tuberculin skin testing of physicians at a midwestern teaching hospital: a 6-year prospective study. Clin Infect Dis 2001;32:13311337.Google Scholar
25.Porteous, NB, Brown, JP. Tuberculin skin test conversion rate in dental health care workers: results of a prospective study. Am J Infect Control 1999;27:385387.CrossRefGoogle ScholarPubMed
26.Panlilio, AL, Burwen, DR, Curtis, AB, et al.Tuberculin skin testing surveillance of HCWs. Clin Infect Dis 2002;35:219227.Google Scholar
27.Do, AN, Limpakarnjarat, K, Uthaivoravit, W, et al.Increased risk of Mycobacterium tuberculosis infection related to the occupational exposures of health care workers in Chiang Rai, Thailand. Int J Tuberc Lung Dis 1999;3:377381.Google Scholar
28.Garcia-Garcia, ML, Jiminez-Corona, A, Jiminez-Corona, ME, et al.Factors associated with tuberculin reactivity in two general hospitals in Mexico. Infect Control Hosp Epidemiol 2001;22:8893.Google Scholar
29.Alonso-Echanove, J, Granich, RM, Laszlo, A, et al.Occupational transmission of Mycobacterium tuberculosis to health care workers in a university hospital in Lima, Peru. Clin Infect Dis 2001;33:589596.Google Scholar
30.Templeton, GL, Illing, LA, Young, L, Cave, D, Stead, WW, Bates, JH. The risk for transmission of Mycobacterium tuberculosis at the bedside and during autopsy. Ann Intern Med 1995;122:922925.CrossRefGoogle ScholarPubMed
31.Institute of Medicine. Tuberculosis in the Workplace. Washington, DC: National Academy Press; 2001:2427.Google Scholar