Christie C D, Constantinou P, Marx M L, Willke M J, Marot K, Mendez F L, Donovan J, Thole J
Division of Infectious Diseases, Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA.
Infect Control Hosp Epidemiol. 1998 Mar;19(3):168-74. doi: 10.1086/647789.
To assess the risk of Mycobacterium tuberculosis infection and disease among patients and workers in a regional pediatric hospital.
Descriptive epidemiological study of the mandatory tuberculin skin testing program of hospital employees at hire and during annual reevaluation, pediatric patients with tuberculosis (TB), efficacy of hospital infection control measures, and community rates of TB.
361-bed, university, pediatric hospital serving Cincinnati (1.7 million population).
During 1986 through 1994, 2,275 to 4,356 employees were compliant with Mantoux skin testing and screening each year. This represented >97% of the population who were eligible for screening. The cumulative rate of M tuberculosis infection from a previous positive tuberculin skin test was 10% to 12% per year during 1986 through 1994. Among new Mantoux skin-test converters in employees at annual reevaluation, the risk of TB infection was 0.3% in 1993 and 1994. There were no active cases of TB identified during new employee screening or annual reevaluation. Of 62 new Mantoux skin-test converters in 9 years, 23% were foreign-born, 13% were Asian, 23% were African American, 11% received the bacillus of Calmette-Guérin vaccine, and 60% had direct patient care or indirect patient contact. A cluster of five converters occurred in a department with no patient care or contact. Mantoux conversion rates were 1.9 per 1,000 employee patient-care or contact-years and 2.2 per 1,000 employee non-patient-contact years. Twenty pediatric patients with active TB were identified during 1991 to 1994, with < or =6 cases per year, placing this hospital in the low-risk category for M tuberculosis disease. Three children with pulmonary TB were admitted without immediate respiratory isolation, possibly exposing 9 patients and 42 employees; none converted their Mantoux skin tests on retesting. Rates of active TB in Cincinnati were stable during the period (eg, 8/100,000 population in 1994).
Despite intense active surveillance among thousands of hospital employees with >97% annual compliance, tuberculin conversion rates were low, and no cases of active TB were identified during 9 years of follow-up. There was no evidence of transmission of M tuberculosis from infected patients to employees during uncontrolled exposures. Rates of TB in the community were low. These data suggest that rigorous application of the Centers for Disease Control and Prevention guidelines and Occupation Safety and Health Administration regulations for preventing nosocomial TB in pediatric hospitals may be excessive and costly. Special provisions should be made for pediatric hospitals with a proven low risk of transmission of M tuberculosis.
评估一家地区性儿科医院的患者及工作人员感染结核分枝杆菌及发病的风险。
对医院员工入职时及年度重新评估时进行的强制性结核菌素皮肤试验项目、患有结核病（TB）的儿科患者、医院感染控制措施的效果以及社区结核病发病率进行描述性流行病学研究。
一家拥有361张床位的大学附属儿科医院，服务于辛辛那提市（人口170万）。
在1986年至1994年期间，每年有2275至4356名员工接受曼托试验（Mantoux）皮肤试验及筛查。这占 eligible for screening。1986年至1994年期间，既往结核菌素皮肤试验呈阳性者每年结核分枝杆菌感染的累积发生率为10%至12%。在年度重新评估时曼托试验皮肤试验新转为阳性的员工中，1993年和1994年结核病感染风险为0.3%。在新员工筛查或年度重新评估期间未发现活动性结核病病例。9年中62名曼托试验皮肤试验新转为阳性者中，23%出生于国外，13%为亚洲人，23%为非裔美国人，11%接种过卡介苗，60%有直接的患者护理或间接的患者接触。在一个无患者护理或接触的科室出现了5例转为阳性的聚集性病例。曼托试验转换率为每1000名有患者护理或接触的员工每年1.9例，每1000名无患者接触的员工每年2.2例。1991年至1994年期间确定了20名患有活动性结核病的儿科患者，每年≤6例，使该医院处于结核病低风险类别。3名肺结核患儿入院时未立即进行呼吸道隔离，可能使9名患者和42名员工暴露；再次检测时他们的曼托试验皮肤试验均未转为阳性。在此期间辛辛那提市的活动性结核病发病率稳定（例如，1994年为8/10万人口）。
尽管对数千名医院员工进行了严格的主动监测且年依从率>97%，但结核菌素转换率较低，且在9年的随访中未发现活动性结核病病例。没有证据表明在未控制的暴露期间结核分枝杆菌从感染患者传播给员工。社区结核病发病率较低。这些数据表明，严格应用疾病控制和预防中心的指南以及职业安全与健康管理局的法规来预防儿科医院的医院内结核病可能过度且成本高昂。对于已证实结核分枝杆菌传播风险较低的儿科医院应做出特殊规定。
