Cookson S T, Jarvis W R
Investigation and Prevention Branch, Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Infect Dis Clin North Am. 1997 Jun;11(2):385-409. doi: 10.1016/s0891-5520(05)70362-7.
The recent resurgence of TB together with the ongoing HIV epidemic has resulted in a larger number of infectious TB patients being admitted to US health care facilities. These patients have become a source for both nosocomial (patient-to-patient) and occupational (patient-to-health care worker) M. tuberculosis transmission. Infectious MDR-TB patients serve as even greater potential infectious sources because they often remain AFB smear and culture positive for months to years. The keys to the prevention of nosocomial and occupational transmission of M. tuberculosis is conducting a risk assessment for each area of the facility and instituting appropriate control measures, having a high index of suspicion by clinicians for infectious TB in those who present with consistent signs and symptoms, rapid triage of such patients to isolation areas and their appropriate clinical work-up, and the institution of effective antituberculous therapy. Infection control personnel should ensure that infectious TB patients are isolated in appropriate isolation rooms (i.e., negative pressure, greater than or equal to 6 ACH, and direct external exhaust of the room air). Health care workers with infectious TB patient contact should be instructed in the epidemiology of M. tuberculosis transmission, the role of respirators in protecting the health care worker from airborne inoculation, and the importance of periodic health care worker TST. The nosocomial TB outbreaks in the 1980s and 1990s document that M. tuberculosis can be transmitted to both patients and health care workers in US health care facilities when appropriate infection control measures are not fully implemented. Follow-up studies at some of these institutions, however, document that when infection control measures similar to the 1990 or 1994 CDC TB Guidelines are fully implemented, M. tuberculosis transmission to both patients and health care workers can be reduced or eliminated. Protection of both patients and health care workers from M. tuberculosis infection is dependent on an understanding and full implementation of the 1994 CDC TB Guidelines.
近期结核病的再度流行，加之持续的艾滋病疫情，导致大量具有传染性的结核病患者被收治入美国的医疗机构。这些患者已成为结核分枝杆菌在医院内（患者之间）和职业环境中（患者至医护人员）传播的源头。具有传染性的耐多药结核病患者更是潜在的巨大传染源，因为他们的痰涂片和培养结果往往数月甚至数年呈抗酸杆菌阳性。预防结核分枝杆菌在医院内和职业环境中传播的关键在于，对医疗机构的每个区域进行风险评估并采取适当的控制措施；临床医生对出现相关症状和体征的患者高度怀疑为传染性结核病；将此类患者迅速分诊至隔离区域并进行适当的临床检查；实施有效的抗结核治疗。感染控制人员应确保将传染性结核病患者隔离在适当的隔离病房（即负压病房，换气次数大于或等于每小时6次，且病房空气直接向外排放）。接触传染性结核病患者的医护人员应接受关于结核分枝杆菌传播流行病学、呼吸器在保护医护人员免受空气传播感染方面的作用以及定期进行医护人员结核菌素皮肤试验重要性的培训。20世纪80年代和90年代美国医院内发生的结核病暴发表明，如果未全面实施适当的感染控制措施，结核分枝杆菌可在美国医疗机构内传播给患者和医护人员。然而，其中一些机构的后续研究表明，若全面实施类似于1990年或1994年美国疾病控制与预防中心结核病指南的感染控制措施，结核分枝杆菌向患者和医护人员的传播可减少或消除。保护患者和医护人员免受结核分枝杆菌感染取决于对1994年美国疾病控制与预防中心结核病指南的理解和全面实施。
