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Tuberculosis Surveillance Practices in Long-Term Care Institutions

Published online by Cambridge University Press:  02 January 2015

Gary Naglie ,
Margaret McArthur ,
Andrew Simor ,
Monika Naus ,
Angela Cheung  and
Allison McGeer
Gary Naglie*
Affiliation:
Department of Medicine, The Toronto Hospital University of Toronto, Toronto, Ontario, Canada
Margaret McArthur
Affiliation:
Department of Microbiology, Princess Margaret and Mount Sinai Hospitals
Andrew Simor
Affiliation:
Departments of Microbiology and Medicine, Sunnybrook Health Science Centre and Baycrest Centre for Geriatric Care
Monika Naus
Affiliation:
Ontario Ministry of Health, Public Health Branch University of Toronto, Toronto, Ontario, Canada
Angela Cheung
Affiliation:
Department of Medicine, Deaconess Hospital, Boston, Massachusetts
Allison McGeer
Affiliation:
Department of Microbiology, Princess Margaret and Mount Sinai Hospitals University of Toronto, Toronto, Ontario, Canada
*
The Toronto Hospital, 200 Elizabeth St., EN G-238, Toronto, Ontario, CanadaM5G 2C4
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Abstract

Objecitves:

To identify the tuberculosis (TB) skin-testing practices of long-term care facilities for the elderly in Toronto, Ontario.

Design:

A telephone survey using a 25-item questionnaire.

Setting:

Twenty-nine nursing homes (NHs) and 26 Homes for the Aged (HFAs) in metropolitan Toronto.

Results:

Thirty-one percent of facilities (17 of 55) had no formal tuberculin skin-testing program, including 52% of NHs (15 of 29) versus 8% of HFAs (2 of 26; P= 0.001). Ninety-two percent of HFAs (24 of 26) compared with 45% of NHs (13 of 29), obtained preadmission or admission skin-test status of residents (P= 0.0005). Annual testing was performed at 46% of HFAs (12 of 26) and 27% of NHs (8 of 29; P= 0.28). Of facilities that carried out any skin testing, 64% of HFAs (16 of 25) versus 32% of NHs (6 of 19) measured induration to establish test positivity (P=0.068). Fifty-two percent of HFAs (13 of 25), compared with 21% of NHs (4 of 19), recorded the actual size of induration in the patient record (P=0.085). Only 28% of HFAs (7 of 25) and 21% of NHs (4 of 19) correctly defined a positive tuberculin skin test.

Conclusions:

TB surveillance practices in long-term care institutions in Toronto are inadequate and often yield results that do not predict the risk of infection and cannot be used to investigate outbreaks. Tuberculin skin-testing practices were better at HFAs, which are subject to provincial legislation regarding TB surveillance, than at NHs, which are not subject to this legislation. Staff at HFAs and NHs require education regarding tuberculin skin-testing policies and procedures.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 16 , Issue 3 , March 1995 , pp. 148 - 151
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1995

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