Stricof R L, DiFerdinando G T, Osten W M, Novick L F
Bureau of Tuberculosis Control, New York State Department of Health, ESP, Albany 12237-0669, USA.
Am J Infect Control. 1998 Jun;26(3):270-6. doi: 10.1016/s0196-6553(98)80012-6.
To assess the implementation of tuberculosis (TB) control measures in New York City hospitals in 1992 and determine trends during the subsequent 2 years.
The 22 acute care facilities with the largest number of hospitalized TB patients in 1991 were selected for inclusion in the study. Medical and laboratory records of the 10 most recent acid fast bacilli (AFB) smear-positive patients in each of the selected facilities in 1992, 1993, and 1994 were reviewed by using a standardized questionnaire to determine risk factors for TB, previous history of TB, clinical signs and symptoms, AFB laboratory turnaround times, emergency department contact, timing of isolation, timing of treatment, case reporting, and status on discharge. The patients' rooms were evaluated for TB environmental control measures if the patient was still on respiratory isolation precautions.
More than one third of patients were admitted with a previous history of TB, 31% were admitted with a cavitary lesion on chest x-ray examination, and 48% were known to have HIV infection. Eighty-five percent were admitted from the emergency department where they stayed for up to 116 hours (mean stay: 17 hours). The proportion of patients placed in AFB isolation on admission to the floor increased from 75% in 1992 to 84% in 1994. The proportion of patients given a minimum of four anti-TB drugs increased from 88% in 1992 to 94% in 1994. Patients "on isolation" were sharing rooms with up to nine other patients in 1992, whereas no patients were sharing rooms in the 1994 survey. In 1992, 51% of the rooms were under negative air flow with respect to the corridor. During the 1994 survey, 80% of rooms were under negative air flow. Between 1992 and 1994, the proportion of AFB isolation rooms with dust/mist respirators increased from 28% to 76% (p < 0.00001). Approximately 25% of discharged patients left against medical advice (no trend over time). The proportion of medically discharged patients with three negative AFB smears before discharge increased from 26% to 48% (p = 0.03) and the proportion referred for directly observed therapy increased from 15% to 53% (p = 0.00001).
TB control efforts in New York City hospitals improved dramatically between 1992 and 1994. The ultimate control of TB will continue to depend on the coordinated efforts within and between health care facilities, providers, and the community.
评估1992年纽约市医院结核病控制措施的实施情况，并确定随后两年的趋势。
选取1991年住院结核病患者数量最多的22家急症护理机构纳入研究。使用标准化问卷对1992年、1993年和1994年各选定机构中最近10例抗酸杆菌（AFB）涂片阳性患者的医疗和实验室记录进行审查，以确定结核病的危险因素、既往结核病病史、临床体征和症状、AFB实验室周转时间、急诊科接触情况、隔离时间、治疗时间、病例报告以及出院状态。如果患者仍在采取呼吸道隔离预防措施，则对其病房的结核病环境控制措施进行评估。
超过三分之一的患者入院时有结核病既往史，31%的患者胸部X线检查显示有空洞性病变，48%的患者已知感染艾滋病毒。85%的患者从急诊科入院，在那里停留长达116小时（平均停留时间：17小时）。入院时被置于AFB隔离的患者比例从1992年的75%增至1994年的84%。接受至少四种抗结核药物治疗的患者比例从1992年的88%增至1994年的94%。1992年，“处于隔离状态”的患者与多达九名其他患者共用病房，而在1994年的调查中没有患者共用病房。1992年，51%的病房相对于走廊处于负压气流状态。在1994年的调查中，80%的病房处于负压气流状态。1992年至1994年期间，配备防尘/防雾呼吸器的AFB隔离病房比例从28%增至76%（p<0.00001）。约25%的出院患者擅自离院（无随时间变化的趋势）。出院前三次AFB涂片阴性的医疗出院患者比例从26%增至48%（p = 0.03），接受直接观察治疗的患者比例从15%增至53%（p = 0.00001）。
1992年至1994年期间，纽约市医院的结核病控制工作有了显著改善。结核病的最终控制将继续依赖于医疗机构内部、医疗机构之间、医护人员以及社区的协同努力。
