Survey of mycobacteriology laboratory practices in an urban area with hyperendemic pulmonary tuberculosis.

SETTING

Rio de Janeiro, Brazil, where 10210 cases of tuberculosis (TB) were reported in 1997, 86.2% of them with pulmonary TB.

OBJECTIVE

To assess laboratory resources, practices, biosafety measures and training needs relative to the volume of work required for the TB control program and implementation of directly observed therapy, short course (DOTS).

DESIGN

A cross-sectional survey of laboratories that receive funds from the public sector and work with mycobacteria, using a structured questionnaire and onsite visits to collect data. The main outcome measure of interest was processing > or = 20 specimens per week.

RESULTS

More than half (56.5%) of the laboratories reported performing < 20 specimens per week, a level at which it is difficult to maintain proficiency in mycobacteriologic techniques. The demand for sputum smear microscopy was not met. Working conditions such as shared laboratory and air space, inadequate ventilation, accidents with biological specimens, and inadequate disposal of biological waste present risks of TB transmission to laboratory workers and other staff.

CONCLUSION

Training and supervising laboratory workers in good technique and biosafety practices and providing the necessary organization, resources and working conditions will strengthen TB control and facilitate implementation of DOTS. Several simple interventions are proposed.