Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-25T18:36:25.188Z Has data issue: false hasContentIssue false
  • English
  • Français

Tuberculosis Epidemic Among Hospital Personnel

Published online by Cambridge University Press:  21 June 2016

Charles E. Haley ,
Robert C. McDonald ,
Lois Rossi ,
Wilbur D. Jones Jr ,
Robert W. Haley  and
James P. Luby
Charles E. Haley
Affiliation:
Department of Internal Medicine, University of Texas South-western Medical Center, Dallas, Texas
Robert C. McDonald
Affiliation:
Department of Internal Medicine, University of Texas South-western Medical Center, Dallas, Texas
Lois Rossi
Affiliation:
Employee Health Service, Parkland Memorial Hospital, Dallas, Texas
Wilbur D. Jones Jr
Affiliation:
Mycobacleriology Section, Baclerial Diseases Division, Center for Infectious Diseases, Centers for Disease Control, Atlanta, Georgia
Robert W. Haley
Affiliation:
Department of Internal Medicine, University of Texas South-western Medical Center, Dallas, Texas
James P. Luby*
Affiliation:
Department of Internal Medicine, University of Texas South-western Medical Center, Dallas, Texas
*
University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75235-8859
Get access Rights & Permissions [Opens in a new window]

Abstract

Six employees of the emergency department at Parkland Memorial Hospital developed active tuberculosis in 1983-1984. Five of the cases occurred four to 12 months after exposure to the index case, a patient with severe cavitary tuberculosis seen in the emergency department in April 1983. One resident physician developed cavitary disease after exposure to this patient. An additional employee case may have resulted from transmission from one of the initial employee cases. One immunocompromised patient may have acquired tuberculosis as a result of exposure to the index case. In addition, the tuberculin skin tests of at least 47 employees exposed to the index case converted from negative to positive. Of 112 previously tuberculin-negative emergency department employees who were tested in October 1983, 16 developed positive skin tests, including the 5 employees with active disease. Fifteen of these new positives had worked on April 7, 1983, while the index case was in the emergency department (x2 = 20.6, P <0.00l). Factors related to the genesis of the epidemic included the disease characteristics in the index case and the recirculation of air in the emergency department. This investigation indicates that city-county hospital emergency department employees should be screened at least twice a year for evidence of tuberculosis and that the employee health services of such hospitals should regard the surveillance of tuberculous infection among personnel at a high-priority level.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 10 , Issue 5 , May 1989 , pp. 204 - 210
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1989

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. Vestal, AL: Procedure, for the Isolation and Identification of Myrobacterio. US Dept of Health. Education and Welfare publication No. (CDC) 81-8230. Atlanta, Centers for Disease Control, 1975.Google Scholar
2. Jones, WD Jr, Good, RC, Thompson, NI, et al: Bacteriophage types of Mycobacterium tuberculosis in the United States. Am Rev Respir Dis. 1982;125:640–643.Google Scholar
3. Scully, RE, Mark, EJ, McNeely, BU: Case records of the Massachusetts General Hospital. Case 5l-1983. N Engl J Med. 1983;309:1569–1574.Google Scholar
4. Guyton, HG, Decker, HM: Respiratory protection provided by five new contagion masks. Applied Microbiology. 1963;11:66–68.Google Scholar
5. Thompson, NJ, Glassioth, JL, Snider, DE Jr, et al: The booster phenomenon in serial tuberculin testing. Am Rev Respir Dis. 1979;119:587–597.Google ScholarPubMed
6. American Thoracic Society Executive Committee: The tuberculin skin test. Am Rev Respir Dis. 1981;124:356–363.Google Scholar
7. Snider, DE Jr: The tuberculin skin test. Am Rev Respir Dis. 1982; 125(Suppl):108–118.Google Scholar
8. Barrett-Connor, E: The epidemiology of tuberculosis in physicians. JAMA. 1979;241:33–38.Google Scholar
9. Alpert, ME. Levison, ME: An epidemic of tuberculosis in a medical school. N Engl Med. 1965;272:718–721.Google Scholar
10. Ehrenkranz, NJ, Kicklighter, JL.:Tuberculosis outbreak in a general hospital: Evidence for airborne spread of infection. Ann Intern Med. 1972;77:377–382.Google Scholar
11. Riley, RL. Weils, WF, Mills, CC. et al: Air hygiene in tuberculosis: Quantitative studies of infectivity and control in a pilot ward. American Review Of Tuberculosis 1957;75:420–431.Google Scholar
12. Riley, RE., Mills, CC, O'Grady, E et al: Infectiousness of air from a tuberculosis ward: Ultraviolet irradiation of infected air: Comparative infections of different patients. Am Rev Respir Dis. 1962;85:511–525.Google Scholar
13. Centers for Disease Control: Guideline, for Prevention of Tuberculosis Transmission in Hospitals. US Dept of Health. Education and Welfare publication No. (CDC) 82-8371. Atlanta, Centers for Disease Control, 1983.Google Scholar
14. Dickinson, JM, Lefford, MJ. Lloyd, J, et al: The virulence in the guinea pig of tubercle bacilli from patients with pulmonary tuberculosis in Hong Kong. Tubercle 1963;44:446–451.Google Scholar
15. Ludmerer, KM. Kissane, JM: Fulminant pneumonia and death in an immunocompromised woman. Am J Med. 1983;75:1043–1052.Google Scholar
16. Reyes, R. Blakey, D, Snider, DE Jr, et al: Transmission of multiple drug-resistant tuberculosis: Report of a school and community outbreak. Am J Epidemiol. 1981;113:423–434.Google Scholar
17. Noble, RC: Infectiousness of pulmonary tuberculosis after starting chemotherapy. Review of the available data on an unresolved question. Am J inject Control. 1981;9:6–10.Google Scholar
18. O'Grady, F, Sultan, LU, Mills, CC, et a1: Effect of chemotherapy on airborne infectivity of tuberculosis. Transactions of the 19th Conference on Chemotherapy Tuberculosis, VA-Armed Forces, Feb 8-11. 1960, 209–216.Google Scholar
19. Loudon, RG, Spohn, SK: Cough frequency and infectivity in patients with pulmonary tuberculosis. Am Rev Respir Dis. 1969;99:109–111.Google Scholar
20. Gunnels, JJ, Bates, JH, SWindoll, H: Infectivity of sputum-positive tuberculous patients on chemotherapy. Am Rev Respir Dis. 1974;109:323–330.Google ScholarPubMed
21. Centers for Disease Control: Use of BCG vaccines in the control of tuberculosis: A joint statement by the ACIP and the advisory committee for the elimination of tuberculosis. MMWR. 1988;37:663–675.Google Scholar