Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, Minnesota.
Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota.
Clin Infect Dis. 2018 Feb 10;66(5):706-711. doi: 10.1093/cid/cix861.
Healthcare workers (HCWs) undergo occupational tuberculosis screening at regular intervals. However, the risk of contracting tuberculosis at the workplace in a setting with a low background tuberculosis incidence is unclear. We aimed to evaluate the risk of tuberculin skin test (TST) conversion and the risk of occupational tuberculosis infection among HCWs in such a setting.
We conducted a retrospective cohort study of employees of a large tertiary medical center in the US Midwest who had undergone TST screening during the study period 1 January 1998 to 31 May 2014.
Among 40142 HCWs who received a TST, only 123 converted over 16.4 years. Only 9 (7%) of the converters had a suspected tuberculosis exposure at the workplace and none developed active tuberculosis. The majority of TST converters (66%) had a negative QuantiFERON-TB test at the time of the conversion.
In one of the largest cohorts of HCWs in a low-tuberculosis-incidence setting, we demonstrated an extremely low risk of occupational tuberculosis exposure among TST converters and no resulting active tuberculosis cases. In this setting, the approach of testing HCWs at baseline and after tuberculosis exposure, rather than at regular intervals, should be considered.
医护人员（HCWs）需定期接受职业性肺结核筛查。然而，在背景肺结核发病率较低的环境中，医护人员在工作场所感染肺结核的风险尚不清楚。我们旨在评估在此类环境中 HCWs 的结核菌素皮肤试验（TST）转化风险和职业性结核感染风险。
我们对美国中西部一家大型三级医疗中心的员工进行了回顾性队列研究，这些员工在研究期间（1998 年 1 月 1 日至 2014 年 5 月 31 日）接受了 TST 筛查。
在接受 TST 筛查的 40142 名 HCWs 中，仅有 123 人在 16.4 年内发生 TST 转化。仅 9 名（7%）转化者在工作场所存在疑似肺结核接触，且均未发展为活动性肺结核。大多数 TST 转化者（66%）在转化时进行的 QuantiFERON-TB 检测为阴性。
在低肺结核发病率环境中 HCWs 的最大队列之一中，我们发现 TST 转化者职业性肺结核接触的风险极低，且无活动性肺结核病例发生。在此类环境中，应考虑仅在接触肺结核后而非定期对 HCWs 进行检测。
