Roy M C, Fredrickson M, Good N L, Hunter S A, Nettleman M D
Division of General Medicine, Clinical Epidemiology and Health Services Research, University of Iowa Hospitals and Clinics, USA.
Infect Control Hosp Epidemiol. 1997 Jan;18(1):28-31. doi: 10.1086/647497.
To determine if compliance with annual tuberculosis skin testing correlated with the number of cases of tuberculosis seen in patients and healthcare workers.
Survey using a written questionnaire.
159 Veterans' Administration facilities.
Hospitals that reported that > 80% of their healthcare workers received annual skin tests saw 12.7 patient cases per 10,000 admissions and 4.0 healthcare worker cases per 10,000 personnel. Facilities in which < 20% of their healthcare workers were given annual skin tests saw 4.5 cases per 10,000 admissions and 1.6 cases in healthcare workers per 10,000 personnel (P < .001 for patients and P = .31 for healthcare workers). The ratio of the median number of patients placed in acid-fast bacilli (AFB) isolation to the median number of patients with confirmed tuberculosis was 12. There was no correlation of this ratio with the number of cases of tuberculosis in patients or healthcare workers seen in each facility.
Compliance with annual tuberculosis skin testing was related directly to the rate of tuberculosis seen in patients. More standardized policies for placing patients in AFB isolation are needed to control for potentially costly variation among facilities. These measures should have highest priority in the control of tuberculosis in the healthcare setting, before implementing still more expensive interventions.
确定医护人员年度结核菌素皮肤试验的依从性是否与患者及医护人员中结核病病例数相关。
采用书面问卷进行调查。
159家退伍军人管理局机构。
报告称超过80%的医护人员接受年度皮肤试验的医院，每10000例入院患者中有12.7例患者感染结核病，每10000名医护人员中有4.0例医护人员感染结核病。医护人员年度皮肤试验接受率低于20%的机构，每10000例入院患者中有4.5例患者感染结核病，每10000名医护人员中有1.6例医护人员感染结核病（患者P <.001，医护人员P = 0.31）。耐酸杆菌（AFB）隔离患者中位数与确诊结核病患者中位数之比为12。该比例与各机构中患者或医护人员的结核病病例数无关。
年度结核菌素皮肤试验的依从性与患者结核病发病率直接相关。需要更标准化的AFB隔离患者政策，以控制各机构间潜在的高成本差异。在实施更昂贵的干预措施之前，这些措施应在医疗机构结核病控制中具有最高优先级。
