Sinkowitz R L, Fridkin S K, Manangan L, Wenger P N, Jarvis W R
Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Am J Infect Control. 1996 Aug;24(4):226-34. doi: 10.1016/s0196-6553(96)90054-1.
Recent nosocomial outbreaks have raised concern about the risk of Mycobacterium tuberculosis transmission in United States hospitals.
To determine current tuberculosis (TB) infection control practices, we surveyed a sample of approximately 3000 acute care facilities about the number of patients with drug-susceptible or multidrug-resistant TB (MDR-TB), health care worker (HCW) tuberculin skin test (TST) results, and compliance with the 1990 Centers for Disease Control and Prevention (CDC) TB guidelines. Analyses were restricted to one response per hospital.
Personnel at 1494 (49.8%) hospitals returned a completed survey. Respondent hospitals had a mean of 881 HCWs (range 8 to 10,000) and 196 (range 6 to 2450) beds; 62% percent were community nonteaching hospitals. Of respondent hospitals providing data for 1989 through 1992, the proportion that cared for patients with TB or MDR-TB increased from 46.4% to 56.6% and 0.8% to 4.5%, respectively. The pooled mean HCW TST positivity rate at hire rose from 0.95% to 1.14%, and the pooled mean HCW TST conversion rate increased from 0.40% to 0.51%. In 1992, when we compared hospitals with zero, one to five, or six or greater patients with TB, the risk of a positive HCW TST result at hire or at routine testing significantly increased with increasing number of patients with TB. From 1989 through 1992, the number of hospitals reporting the use of surgical masks for HCW respiratory protection decreased from 96.8% to 66.8%. In 1992, 66% of the hospitals reported compliance with four or more of the AFB isolation room criteria specified in the 1990 CDC TB guidelines.
Contrary to prior surveys, this study shows that many U.S. community hospitals admit patients with TB less frequently than do teaching hospitals, and infrequently admit patients with MDR-TB. Because the risk of HCW TST conversion varies with hospital characteristics, these data show the importance of performing a risk assessment, as recommended in the CDC TB guidelines, for each ward and hospital so that TB control measures can be individualized.
近期医院内的疫情爆发引发了人们对美国医院中结核分枝杆菌传播风险的担忧。
为确定当前结核病（TB）感染控制措施，我们对约3000家急症护理机构进行了抽样调查，内容包括药敏或耐多药结核病（MDR-TB）患者数量、医护人员（HCW）结核菌素皮肤试验（TST）结果以及对1990年疾病控制与预防中心（CDC）结核病指南的遵守情况。分析仅限于每家医院的一份回复。
1494家（49.8%）医院的人员返回了完整的调查问卷。参与调查的医院平均有881名医护人员（范围为8至10000名）和196张床位（范围为6至2450张）；62%为社区非教学医院。在提供1989年至1992年数据的参与调查医院中，收治结核病或耐多药结核病患者的比例分别从46.4%增至56.6%以及从0.8%增至4.5%。入职时医护人员TST阳性率的合并均值从0.95%升至1.14%，医护人员TST转化率的合并均值从0.40%增至0.51%。1992年，当我们比较收治结核病患者数量为零、一至五名或六名及以上的医院时，入职时或常规检测时医护人员TST结果呈阳性的风险随着结核病患者数量的增加而显著上升。从1989年至1992年，报告为医护人员提供呼吸防护而使用外科口罩的医院数量从96.8%降至66.8%。1992年，66%的医院报告遵守了1990年CDC结核病指南中规定的四项或更多抗酸杆菌隔离室标准。
与之前的调查相反，本研究表明，许多美国社区医院收治结核病患者的频率低于教学医院，且很少收治耐多药结核病患者。由于医护人员TST转化的风险因医院特征而异，这些数据表明按照CDC结核病指南的建议对每个病房和医院进行风险评估的重要性，以便能够制定个性化的结核病控制措施。
