Menzies D, Fanning A, Yuan L, FitzGerald J M
Montreal Chest Institute, 3650 St. Urbain Street, Montreal, Quebec H2X 2P4, Canada.
Ann Intern Med. 2000 Nov 21;133(10):779-89. doi: 10.7326/0003-4819-133-10-200011210-00010.
The risk for and determinants of transmission of tuberculosis in hospitals caring for moderate numbers of patients with tuberculosis remain uncertain.
To study the association of tuberculin conversion among health care workers with ventilation of patient care areas.
Cross-sectional observational survey.
17 acute-care community or university hospitals.
All personnel who worked at least 2 days per week in the respiratory and physiotherapy departments or in selected nursing units.
Participating workers underwent tuberculin skin testing and completed self-administered questionnaires. Previous tuberculin tests and bacille Calmette-Guérin vaccinations were verified. Records of patients with tuberculosis who were hospitalized in the 3 years preceding the study were reviewed. Air exchanges per hour in patient care areas were measured by using a tracer gas technique. Multivariate proportional hazards regression was used to estimate the effect of occupational factors on documented tuberculin conversion, after adjustment for nonoccupational factors, among participants with at least one previous negative result on tuberculin skin testing.
Tuberculin conversion was associated with ventilation of general or nonisolation patient rooms of less than 2 air exchanges per hour (adjusted hazard ratio, 3.4 [95% CI, 2.1 to 5.8]); with work in moderate- to high-risk hospitals (adjusted hazard ratio, 2.2 [CI, 1.3 to 3.5]); and with work in the nursing (adjusted hazard ratio, 4.3 [CI, 2.7 to 6.9]), respiratory therapy (adjusted hazard ratio, 6.1 [CI, 3.1 to 12.0]), and physiotherapy (adjusted hazard ratio, 3.3 [CI, 1.5 to 7.2]) departments or housekeeping (adjusted hazard ratio, 4.2 [CI, 2.3 to 7.6]). Conversion was not associated with inadequate ventilation of respiratory isolation rooms (adjusted hazard ratio, 1.0 [CI, 0.8 to 1.3]).
Tuberculin conversion among health care workers was strongly associated with inadequate ventilation in general patient rooms and with type and duration of work, but not with ventilation of respiratory isolation rooms.
在收治适量结核病患者的医院中，结核病传播的风险及决定因素仍不明确。
研究医护人员结核菌素阳转与患者护理区域通风情况之间的关联。
横断面观察性调查。
17家急症社区医院或大学医院。
所有每周至少在呼吸科、理疗科或选定护理单元工作2天的人员。
参与研究的工作人员接受结核菌素皮肤试验，并完成自行填写的问卷。核实既往结核菌素试验及卡介苗接种情况。回顾研究前3年住院的结核病患者记录。采用示踪气体技术测量患者护理区域的每小时换气次数。在至少有一次既往结核菌素皮肤试验结果为阴性的参与者中，使用多变量比例风险回归分析评估职业因素对记录在案的结核菌素阳转的影响，并对非职业因素进行调整。
结核菌素阳转与普通或非隔离病房每小时换气次数少于2次的通风情况相关（调整后风险比为3.4[95%CI，2.1至5.8]）；与在中高风险医院工作相关（调整后风险比为2.2[CI，1.3至3.5]）；与在护理（调整后风险比为4.3[CI，2.7至6.9]）、呼吸治疗（调整后风险比为6.1[CI，3.1至12.0]）、理疗（调整后风险比为3.3[CI，1.5至7.2]）科室或保洁部门工作相关（调整后风险比为4.2[CI，2.3至7.6]）。结核菌素阳转与呼吸道隔离病房通风不足无关（调整后风险比为1.0[CI，0.8至1.3]）。
医护人员结核菌素阳转与普通病房通风不足以及工作类型和时长密切相关，但与呼吸道隔离病房通风情况无关。
