Tuberculosis screening for hospital employees. A five-year experience in a large community hospital.

A 5-year experience in developing an annual tuberculosis screening program for employees of a 570-bed community hospital in a state with a low endemic rate of tuberculosis is described. Using a computerized payroll system to notify employees and the incentive of free lunch tickets, the program reached more than 95 per cent of the eligible employees. No active cases and only 7 skin test conversions (0.11 per cent) were found during the 5-year period; only 3 of the 7 converters worked in patient care. Three other converters (1.03 per cent) were found among the 291 employee contracts of 20 patients who were initially undiagnosed. The costs for comprehensive screening were high in relation to the low conversion rates found, and more selective screening may be justified in similar hospitals where the risk of acquiring tuberculosis is low. Nonetheless, because the problem of poor compliance was managed successfully, the program has provided an effective measure of protection for both patients and personnel.