Sutton P M, Nicas M, Harrison R J
Public Health Institute, School of Public Health, University of California, Berkeley, USA.
Infect Control Hosp Epidemiol. 2000 Jan;21(1):28-32. doi: 10.1086/501693.
To evaluate implementation of healthcare worker exposure control measures for tuberculosis (TB)-patient isolation, as specified by Centers for Disease Control and Prevention (CDC) guidelines and the hospital's TB-control policy.
Prospective multihospital study comparing CDC guidelines and hospital policy for TB-patient isolation to once-weekly observations of TB-patient isolation practices over 14 consecutive weeks at each hospital.
Three urban hospitals (two county, one private community) in counties in California with a high incidence rate of TB.
Work practices for TB-patient isolation were observed and ventilation performance of isolation rooms was assessed while patient rooms were in use for TB isolation.
Of 170 TB-patient rooms observed, 119 (70%) involved a patient in a designated TB isolation room, the room was under negative pressure, the door was closed, and a "respiratory precautions" sign was on the door; 32 patient-room units (19%) were not under negative pressure or not designated as negative-pressure rooms. Of 151 patient-room units mechanically capable of negative pressure at a prior point in time, 16 (11%) were not under negative pressure at the time of use. Of 67 patient-room units equipped with continuous monitoring devices, 8 (12%) involved devices that did not accurately reflect the direction of airflow. Of the 62 healthcare workers observed using a respirator for TB, 40 (65%) did not don the respirator properly.
Implementing CDC guidelines for TB-patient isolation was feasible but imperfect in the three hospitals. Day-to-day work practices deviated from hospital policy. Prospectively quantifying the implementation of a hospital TB isolation policy while the room is in use may lead to improved estimates of risk and may help to identify and thereby prevent avoidable healthcare worker exposures to Mycobacterium tuberculosis aerosol. Auditing practices and verifying equipment performance is likely to identify unexpected problems in implementation of the TB control program.
根据美国疾病控制与预防中心（CDC）指南及医院结核病控制政策，评估针对肺结核（TB）患者隔离的医护人员接触控制措施的实施情况。
多医院前瞻性研究，将CDC肺结核患者隔离指南及医院政策与各医院连续14周每周一次的肺结核患者隔离措施观察情况进行比较。
加利福尼亚州结核病高发县的三家城市医院（两家县级医院、一家私立社区医院）。
观察肺结核患者隔离的工作措施，并在患者病房用于肺结核隔离时评估隔离病房的通风性能。
在观察的170间肺结核患者病房中，119间（70%）有患者在指定的肺结核隔离病房，病房为负压，门关闭，门上有“呼吸道隔离预防措施”标识；32个病房单元（19%）未处于负压状态或未被指定为负压病房。在之前某个时间点具备机械负压能力的151个病房单元中，有16个（11%）在使用时未处于负压状态。在配备持续监测设备的67个病房单元中，有8个（12%）的设备未准确反映气流方向。在观察的62名使用呼吸器护理肺结核患者的医护人员中，40名（65%）未正确佩戴呼吸器。
在这三家医院实施CDC肺结核患者隔离指南可行但并不完美。日常工作措施与医院政策存在偏差。在病房使用期间前瞻性地量化医院肺结核隔离政策的实施情况，可能会改进风险评估，并有助于识别并预防医护人员接触结核分枝杆菌气溶胶的可避免情况。审核措施并核查设备性能可能会发现结核病控制项目实施过程中出现的意外问题。
