Solano Bernad Víctor Manuel, Hernández Navarrete María Jesús, Martín Sánchez Juan Ignacio, Martínez Sánchez Elena Vanessa, Arribas Llorente José Luis
Servicio de Medicina Preventiva Hospital Universitario Miguel Servet Paseo Isabel la Católica 1-3 50009 Zaragoza.
Rev Esp Salud Publica. 2003 Mar-Apr;77(2):197-5.
Those working in a hospital environment are exposed to different occupational risks, although more specifically biological ones. One of the major risks is that of exposure by airborne transmission, more specifically, tuberculosis. This study is aimed at providing a description and analysis of the results of the implementation of an evaluation and surveillance protocol following occupational exposure to Multiresistant mycobacterium bovis (MRMb).
A male patient was diagnosed with MRMb infection at the Miguel Servet Hospital in Zaragoza in 1999 following ten days without respiratory isolation. During this period, he came into contact with 167 employees from different hospital departments. A surveillance and contact control protocol was prepared based on: completing a survey and undergoing an initial Mantoux (if the employee had previously tested negative for tuberculin), followed three months later by a chest X-ray and then a two-year clinical follow-up (check-ups every three months) for those having tested positive for tuberculin and no administering of chemoprophylaxis even though signs of infection were to have been found.
Information was gathered on 160 employees (96%). A total of 94 employees (59%) had previously undergone a Mantoux, seven (7) having had tuberculosis. It was necessary for a follow-up to be conducted on sixty-one (61) employees who tested positive (29 previously positive and 32 detected in the initial Mantoux). No employee who had tested negative on an initial Mantoux tested positive on repeated testing three months later nor showed any symptoms indicative of transmission during the follow-up period. Some variables, such as age or working in the Infectious Disease Unit were related, on a statistically significant basis, to follow-up being required.
The risk of occupational transmission following contact with MRMb might be similar to M. Tuberculosis, although further experience would be required in order to confirm this fact. Early diagnosis and availing of a protocol for implementing measures aimed at preventing and controlling this type of occupational exposure are of importance.
在医院环境中工作的人员面临不同的职业风险，尤其是生物性风险。主要风险之一是通过空气传播的暴露风险，更具体地说是结核病。本研究旨在描述和分析在职业暴露于多重耐药牛分枝杆菌（MRMb）后实施评估和监测方案的结果。
1999年，一名男性患者在萨拉戈萨的米格尔·塞尔维特医院被诊断为MRMb感染，此前十天未进行呼吸道隔离。在此期间，他与来自不同医院科室的167名员工有过接触。基于以下内容制定了一项监测和接触控制方案：完成一项调查并进行初次结核菌素试验（如果员工此前结核菌素检测呈阴性），三个月后进行胸部X光检查，然后对结核菌素试验呈阳性的员工进行为期两年的临床随访（每三个月检查一次），即使发现感染迹象也不进行化学预防。
收集了160名员工（96%）的信息。共有94名员工（59%）此前进行过结核菌素试验，其中7人（7%）曾患结核病。有必要对61名检测呈阳性的员工进行随访（29名此前呈阳性，32名在初次结核菌素试验中检测出阳性）。初次结核菌素试验呈阴性的员工在三个月后的重复检测中均未呈阳性，且在随访期间未出现任何传播迹象。一些变量，如年龄或在传染病科工作，在统计学上与需要随访有显著相关性。
接触MRMb后的职业传播风险可能与结核分枝杆菌相似，不过需要更多经验来证实这一事实。早期诊断以及采用旨在预防和控制此类职业暴露的措施方案非常重要。
