Stuart R L, Bennett N J, Forbes A B, Grayson M L
Department of Infectious Diseases and Clinical Epidemiology, Monash Medical Centre, Melbourne, VIC.
Med J Aust. 2001 Jun 4;174(11):569-73. doi: 10.5694/j.1326-5377.2001.tb143437.x.
To determine the potential prevalence of nosocomial infection with Mycobacterium tuberculosis among hospital employees in teaching hospitals in Melbourne.
Cross-sectional survey of positive tuberculin skin test (Mantoux) responses among employees in 14 public hospitals in Melbourne, January 1996 to April 1999.
All consenting employees in participating hospitals (4,070 healthcare and 4,298 non-healthcare workers; participation rates, 13%-66%).
Prevalence of positive responses to tuberculin skin tests among healthcare and non-healthcare workers and association with employee and hospital characteristics.
Healthcare workers were significantly more likely to have a positive tuberculin response than non-healthcare workers (19.3% versus 13.7%; odds ratio, 1.5; 95% CI, 1.3-1.7; P<0.001). Multivariable analysis revealed that age, country of birth (high versus low tuberculosis [TB] prevalence), history of BCG (bacille Calmette-Guérin) vaccination, years since last BCG, occupation (healthcare versus non-healthcare worker) and years of hospital employment were all significantly associated with a positive response. Rates of positive responses among employees varied greatly between hospitals (6%-35%). These differences were not explained by employee characteristics, hospital TB patient load (number of admissions or bed-days) or percentage of hospital patients from countries with high TB prevalence. The hospital with the highest rate of positive responses was notable for its lack of negative-pressure isolation rooms for TB patients.
Positive tuberculin responses are relatively common among hospital employees in Melbourne, with rates varying between hospitals and being higher among healthcare than non-healthcare workers. Employee characteristics, such as age, country of birth and past BCG status, explain little of this variation. More emphasis on TB infection control measures and regular staff screening may be needed.
确定墨尔本教学医院的医院员工中结核分枝杆菌医院感染的潜在患病率。
1996年1月至1999年4月对墨尔本14家公立医院员工结核菌素皮肤试验（曼托试验）阳性反应进行的横断面调查。
参与医院中所有同意参与的员工（4070名医护人员和4298名非医护人员；参与率为13%-66%）。
医护人员和非医护人员中结核菌素皮肤试验阳性反应的患病率以及与员工和医院特征的关联。
医护人员结核菌素反应呈阳性的可能性显著高于非医护人员（19.3%对13.7%；优势比为1.5；95%置信区间为1.3-1.7；P<0.001）。多变量分析显示，年龄、出生国家（结核病[TB]高患病率国家与低患病率国家）、卡介苗（卡介苗）接种史、上次接种卡介苗后的年限、职业（医护人员与非医护人员）以及在医院工作的年限均与阳性反应显著相关。不同医院员工的阳性反应率差异很大（6%-35%）。这些差异无法通过员工特征、医院结核病患者负荷（入院人数或住院天数）或来自结核病高患病率国家的医院患者百分比来解释。阳性反应率最高的医院以缺乏用于结核病患者的负压隔离病房而著称。
在墨尔本的医院员工中，结核菌素阳性反应相对常见，不同医院的反应率有所不同，医护人员中的反应率高于非医护人员。年龄、出生国家和既往卡介苗接种状况等员工特征对这种差异的解释作用不大。可能需要更加强调结核病感染控制措施和定期员工筛查。
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