Franchi A, Banfi M B, Franco G
Servizio e Scuola di Specializzazione in Medicina del Lavoro, Università di Modena e Reggio Emilia, Servizio di Sorveglianza Sanitaria, Azienda Policlinico di Modena.
Med Lav. 2003 Nov-Dec;94(6):506-20.
Health care workers (HCWs) are occupationally exposed to a multitude of biological hazards, and among these to the risk of tuberculosis (TB) infection, especially involving individuals working in specific workplace (TB and Chest divisions, Infectious Diseases wards, Microbiology laboratories) and performing thoracic endoscopy and "cough-inducing" procedures. According to national legislation (title VIII D.lgs. 626/94, 1998 Health Minister guide lines document) concerning the control and prevention of TB transmission among HCWs, health care facilities are required to (i) perform an accurate risk assessment and (ii) implement an exposure control plan and worker health surveillance program, thus involving the occupational health professionals.
The aim of this paper is to provide a general view of the epidemiological and scientific evidence related to the effectiveness of health interventions in the prevention of occupational TB infection.
Comparative evaluation and critical review of U.S. CDC (1994) guidelines, OSHA (1997) rules, and the most recent ATS and CDC (2000) "statement" documents.
In low risk groups TCT shows decreased positive predictive value, high variability, and can be confounded by other factors (age, BCG, MNT), thus reducing its diagnostic value for latent TB infection.
Recent recommendations on the control of TB infection in health care settings underline the need of implementing accurate risk evaluation in all hospital units, compared to the epidemiological profile in the community, and "targeted tuberculin testing" programs among high risk HCWs.
医护人员职业暴露于多种生物危害中，其中包括感染结核病（TB）的风险，特别是在特定工作场所（结核病与胸部疾病科、传染病病房、微生物实验室）工作且进行胸腔内镜检查和“诱导咳嗽”操作的人员。根据国家关于医护人员中结核病传播控制与预防的立法（第VIII部，1994年第626号总统令，1998年卫生部指导方针文件），医疗机构必须（i）进行准确的风险评估，以及（ii）实施暴露控制计划和工作人员健康监测计划，从而涉及职业健康专业人员。
本文旨在全面介绍与预防职业性结核病感染的健康干预措施有效性相关的流行病学和科学证据。
对美国疾病控制与预防中心（1994年）指南、职业安全与健康管理局（1997年）规则以及美国胸科学会和疾病控制与预防中心（2000年）“声明”文件进行比较评估和批判性审查。
在低风险人群中，结核菌素皮肤试验（TCT）显示阳性预测值降低、变异性高，并且可能被其他因素（年龄、卡介苗接种、结核菌素纯蛋白衍生物）混淆，从而降低其对潜伏性结核感染的诊断价值。
近期关于医疗机构中结核病感染控制的建议强调，与社区的流行病学特征相比，所有医院科室都需要进行准确的风险评估，以及对高风险医护人员实施“针对性结核菌素检测”计划。
