Louther J, Rivera P, Feldman J, Villa N, DeHovitz J, Sepkowitz K A
St. Clare's Hospital and Health Center, SUNY Health Science Center at Brooklyn, USA.
Am J Respir Crit Care Med. 1997 Jul;156(1):201-5. doi: 10.1164/ajrccm.156.1.9611091.
Concern about the risk to health care workers of occupationally acquired tuberculosis has resulted in extensive and frequently revised guidelines from the Centers for Disease Control and Prevention (CDC). Most recent studies, however, have determined that community, rather than occupational, exposure is the more significant risk for tuberculin conversion. To assess the relative contribution of community versus occupational risk, we reviewed the health records of 1,303 persons employed from 1991 to 1994 at St. Clare's Hospital in New York City, a hospital with a high tuberculosis case-rate. Demographic information included age, gender, postal zone of residence, country of birth, and BCG vaccination status, while occupations were placed into one of five groups. In multivariate analysis, occupation was significantly associated with risk of tuberculin conversion, while postal zone of residence was not. The group that included housekeeping, laundry, and security personnel and the physician-nurse group had the highest conversion rates. After implementation of CDC guidelines, there was a significant improvement in the employee tuberculin conversion rate. At our hospital, occupation was strongly associated with risk of tuberculin conversion.
对医护人员职业性感染结核病风险的担忧促使美国疾病控制与预防中心（CDC）出台了内容广泛且频繁修订的指南。然而，最近的研究表明，社区接触而非职业接触才是结核菌素阳转更重要的风险因素。为评估社区风险与职业风险的相对影响，我们查阅了1991年至1994年在纽约市圣克莱尔医院工作的1303名员工的健康记录，该医院结核病发病率较高。人口统计学信息包括年龄、性别、居住邮政区、出生国家和卡介苗接种状况，职业则分为五组之一。在多变量分析中，职业与结核菌素阳转风险显著相关，而居住邮政区则不然。包括家政、洗衣和安保人员的组以及医生 - 护士组的阳转率最高。在实施CDC指南后，员工结核菌素阳转率有了显著改善。在我们医院，职业与结核菌素阳转风险密切相关。
