Meredith S, Watson J M, Citron K M, Cockcroft A, Darbyshire J H
Department of Epidemiology and Medical Statistics, London Hospital Medical College.
BMJ. 1996 Aug 31;313(7056):522-5. doi: 10.1136/bmj.313.7056.522.
To determine whether healthcare workers in England and Wales are at increased risk of tuberculosis and to examine the frequency of drug resistance in this population.
Comparison of notification rates by occupation obtained from national tuberculosis notification surveys in 1988 and 1993, with denominators from the 1991 census.
People with notified tuberculosis in professional and associate professional occupations from the two surveys.
Rates of notified tuberculosis in health professionals (mainly doctors) and health associate professionals (mainly nurses) compared with rates in other professional and associate professional occupations, adjusted for ethnic group, sex, and age.
119 cases of tuberculosis were identified in healthcare workers, including 61 nurses and 42 doctors. The crude notification rate in healthcare workers was 11.8 per 100,000 per year (95% confidence interval 9.8 to 14.1) compared with 3.3 per 100,000 per year (2.9 to 3.6) in other professional and associate professional occupations; rate ratios were higher (range 1.7 to 3.2) in all ethnic groups. The relative risk adjusted for ethnic group, sex, and age was 2.4 (95% confidence interval 2.0 to 3.0), slightly higher for health professionals (2.7 (1.9 to 3.8)) than for associate professionals (2.0 (1.5 to 2.6)). No multiple drug resistant strains of tuberculosis were identified in healthcare workers.
Better detection and notification of cases of tuberculosis in healthcare workers may account for some of the apparent increased risk, but these findings imply that tuberculosis remains a hazard for healthcare workers and highlight the importance of ensuring that occupational health monitoring and protection workers are not neglected.
确定英格兰和威尔士的医护人员患结核病的风险是否增加，并调查该人群中耐药情况的发生频率。
比较1988年和1993年全国结核病通报调查中按职业划分的通报率，并以1991年人口普查数据作为分母。
两次调查中通报患结核病的专业及准专业职业人员。
将卫生专业人员（主要为医生）和卫生准专业人员（主要为护士）的结核病通报率与其他专业及准专业职业人员的通报率进行比较，并根据种族、性别和年龄进行调整。
在医护人员中确诊119例结核病，其中包括61名护士和42名医生。医护人员的粗通报率为每年每10万人11.8例（95%置信区间9.8至14.1），而其他专业及准专业职业人员的粗通报率为每年每10万人3.3例（2.9至3.6）；所有种族的率比均更高（范围为1.7至3.2）。经种族、性别和年龄调整后的相对风险为2.4（95%置信区间2.0至3.0），卫生专业人员（2.7（1.9至3.8））略高于准专业人员（2.0（1.5至2.6））。在医护人员中未发现耐多药结核菌株。
医护人员中结核病病例检测和通报情况的改善可能是导致风险明显增加的部分原因，但这些发现表明结核病对医护人员仍然是一种危害，并突出了确保职业健康监测和保护工作不被忽视的重要性。
