Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-28T16:11:48.676Z Has data issue: false hasContentIssue false
  • English
  • Français

Screening of Physicians for Tuberculosis

Published online by Cambridge University Press:  02 January 2015

Victoria J. Fraser ,
Charles M. Kilo ,
Thomas C. Bailey ,
Gerald Medoff  and
W. Claiborne Dunagan
Victoria J. Fraser*
Affiliation:
Division of Infectious Disease, Department of Medicine, Washington University School of Medicine and Barnes Hospital, St. Louis, Missouri.
Charles M. Kilo
Affiliation:
Division of Infectious Disease, Department of Medicine, Washington University School of Medicine and Barnes Hospital, St. Louis, Missouri.
Thomas C. Bailey
Affiliation:
Division of Infectious Disease, Department of Medicine, Washington University School of Medicine and Barnes Hospital, St. Louis, Missouri.
Gerald Medoff
Affiliation:
Division of Infectious Disease, Department of Medicine, Washington University School of Medicine and Barnes Hospital, St. Louis, Missouri.
W. Claiborne Dunagan
Affiliation:
Division of Infectious Disease, Department of Medicine, Washington University School of Medicine and Barnes Hospital, St. Louis, Missouri.
*
Washington University School of Medicine, Infectious Disease Division, Campus Box 8051, 660 S. Euclid, St. Louis, MO 63110
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To determine the prevalence of tuberculous infection among a sample of physicians at Barnes Hospital and to determine the frequency of tuberculin skin testing and the adequacy of follow-up for physicians with positive tuberculin skin tests.

Design:

Convenience sample.

Setting

1,000-bed, university-affiliated tertiary care hospital.

Subjects

Physicians attending departmental conferences were screened for tuberculosis. Prior history of tuberculosis, antituberculous therapy, BCG vaccination, and previous tuberculin skin test results were obtained with a standardized questionnaire. Tuberculin skin tests were performed on those who were previously skintest negative.

Outcome Measure:

Tuberculosis infection, prophylactic therapy.

Results:

Eighty-six (24.5%) of 351 physicians in the study were skin test positive by history or currently performed skin test. Of 61 who reported a previously reactive skin test, 40 (66%) had been eligible for isoniazid prophylaxis, but only 15 (37.5%) of 40 had completed at least six months of therapy. Of 290 physicians reporting a previously negative skin test, 25 conversions (8.6%) were identified. Previously undiagnosed, asymptomatic pulmonary tuberculosis was identified in one physician.

Conclusions

Infection with Mycobacterium tuberculosis is common among physicians. Physicians were screened irregularly for tuberculosis, and the use of prophylactic therapy was inconsistent. Aggressive tuberculosis screening programs for healthcare workers should be instituted.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 15 , Issue 2 , February 1994 , pp. 95 - 100
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1994

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. Dooley, SW, Jarvis, WR, Martone, WJ, Snider, DE Jr. Multidrug-resistant tuberculosis. Ann Intern Med 1992;117:257–258.CrossRefGoogle ScholarPubMed
2. Reider, HC, Cauthen, GM, Comstock, GW, Snider, DE. Epidemiology of tuberculosis in the United States. Epidemiol Rev 1989;11:79–98.CrossRefGoogle Scholar
3. Jereb, JA, Kelly, GD, Dooley, SW, Cauthen, GM, Snider, DE. Tuberculosis morbidity in the United States. MMWR 1991;40(SS-3):23.Google ScholarPubMed
4. Pearson, MC, Jereb, JA, Frieden, TR, et al. Nosocomial transmission of Mycobacterium tuberculosis. A risk to patients and health care workers. Ann Intern Med 1992;117:191–196.CrossRefGoogle ScholarPubMed
5. Dooley, SW, Villarino, ME, Lawrence, M, et al. Nosocomial transmission of tuberculosis in a hospital unit for HIV-infected patients. JAMA 1992;267:2632–2635.CrossRefGoogle Scholar
6. Fischi, MA, Uttamchandane, RB, Darkos, GL, et al. An outbreak of tuberculosis caused by multiple drug-resistant tubercle bacilli among patients with HIV infection. Ann Intern Med 1992;177:177–183.Google Scholar
7. Edlin, BR, Tokars, JI, Grieco, MH, et al. An outbreak of multiresistant tuberculosis among hospitalized patients with the acquired immunodeficiency syndrome. N Engl J Med 1992;326(23):1514–1521.CrossRefGoogle Scholar
8. Tokars, JI, Jarvis, WR, Edlin, BR, et al. Tuberculosis skin testing of hospital employees during an outbreak of multidrug-resistant tuberculosis in HIV-infected patients. Infect Control Hosp Epidemiol 1992;13;509–510. Letter.Google ScholarPubMed
9. Barrett-Connor, E. The epidemiology of tuberculosis in physicians. JAMA 1979;241:33–38.CrossRefGoogle ScholarPubMed
10. Malasky, C. Jordan, T, Potulski, F, Reichman, LB. Occupational tuberculosis infections among pulmonary physicians in training. Am Rev Respir Dis 1990;142:505–507.CrossRefGoogle ScholarPubMed
11. Centers for Disease Control. Guidelines for preventing the transmission of tuberculosis in health-care settings with special focus on HIV-related issues. MMWR 1990;39(no. RR17).Google Scholar
12. American Thoracic Society, Centers for Disease Control. Diagnostic standards and classification of tuberculosis. Am Rev Respir Dis 1990;142:725–735.CrossRefGoogle Scholar
13. American Thoracic Society, Centers for Disease Control. Treatment of tuberculosis and tuberculosis infection in adults and children. Am Rev Respir Dis 1986;134:355–363.Google Scholar
14. Haley, CE, McDonald, RC, Rossi, L, Jones, WD, Haley, RW, Luby, JI? Tuberculosis epidemic among hospital personnel. Infect ControlHosp Epidemiol 1989; 10:204–210.CrossRefGoogle ScholarPubMed
15. Goldman, KP. Tuberculosis in hospital doctors. Tubercle 1988;69:237–240.CrossRefGoogle ScholarPubMed
16. The infection of hospital and sanitorium employees. Tubercle 1926;7:347–349.Google Scholar
17. Farer, LS, Atkinson, ML. Tuberculosis and the health worker. Am J Public Health 1981;71:1200–1201 CrossRefGoogle ScholarPubMed
18. Brown, HP, Kane, LW. Pulmonary tuberculosis in Harvard medical students. N Engl J Med 1946;235:315–321.Google Scholar
19. Bradley, L, Tuberculosis in hospital personnel. JAMA 1940;114:102–106.Google Scholar
20. Weiss, W. Tuberculosis in student nurses at Philadelphia General Hospital. Am Rev Respir Dis 1973;107:136–139.Google ScholarPubMed
21. Vogeler, DM, Burke, JP, Tuberculosis screening for hospital employees with five years experience in a large hospital. Am Rev Respir Dis 1978;117:227–232.Google Scholar
22. Atuk, NO, Hunt, EH. Serial tuberculin testing and isoniazid therapy in general hospital employees. JAMA 1971.CrossRefGoogle ScholarPubMed
23. Aitken, ML, Anderson, KM, Albert, RK. Is the tuberculosis screening program of hospital employees still required? Am Rev Respir Dis 1987;136:805–807.CrossRefGoogle ScholarPubMed
24. Selwyn, PA, Hartel, P, Lewis, VA. A prospective study of the risk of tuberculosis among IVDU with HIV N Engl J Med 1989;320:545–550.Google Scholar
25. Geisler, PJ, Nelson, KI, Crispen, RJ. Tuberculosis in physicians. Compliance with preventive measures. Am Rev Respir Dis 1987;135:3–9.Google Scholar
26. Centers for Disease Control. Screening for tuberculosis and tuberculosis infection in high-risk populations and the use of preventive therapy for tuberculosis infection in the U.S. Recommendations of the Advisory Committee for Elimination of Tuberculosis. MMWR 1990;39(no.RR-8).Google Scholar
27. Centers for Disease Control. TB Statistics in the U.S., 1988. Atlanta, GA; HHS publication CDC 90-8322.Google Scholar
28. Poland, GA, Nichol, KL. Medical schools and immunization policies: missed opportunities for disease prevention. Ann Intern Med 1990;13:628–631.CrossRefGoogle Scholar
29. Orenstein, WA, Heseltine, P, Leganoux, ST, et al. Rubella vaccine and susceptible hospital employees: poor physician participation. JAMA 1981;245:711–713.Google Scholar
30. Munaz, DL, Weatherly, MR, Sperling, JL, Fusquoks, CJ. Identification and immunization of healthcare personnel: critical appraisal of a voluntary program. Am J Infect Control 1983;11:1–9.Google Scholar
31. Ramirez, JA, Anderson, P, Herb, S, Raff, MJ. Increased rate of tuberculin skin test conversion among workers at a university hospital. Infect Control Hosp Epidemiol 1992;13:579–581.CrossRefGoogle ScholarPubMed
32. Frampton, MW. An outbreak of tuberculosis among hospital personnel caring for a patient with a skin ulcer. Ann Intern Med 1992;117:312–313.Google Scholar
33. Hutton, MD, Stead, WW, Callthen, GM, Block, AB, Ewing, WM. Nosocomial transmission of tuberculosis associated with a draining abscess. J Infect Dis 1990;161:286–295.Google Scholar