Prezant D J, Kelly K J, Mineo F P, Janus D, Karwa M L, Futterman N, Nolte C
Bureau of Health Services, New York City Fire Department, NY, USA.
Ann Emerg Med. 1998 Aug;32(2):208-13. doi: 10.1016/s0196-0644(98)70138-6.
To determine annual tuberculin skin test conversion (infection) rates for prehospital health care workers (EMTs and paramedics) in an urban environment with a high prevalence of Mycobacterium tuberculosis.
We conducted a prospective study of prehospital health care workers for the New York City EMS, EMS Employee Health Service, and the Fire Department Bureau of Health Service to determine the tuberculin skin test conversion rates. In 1992, all current and new EMS prehospital health care workers without a known history of a positive tuberculin reaction received a baseline tuberculin purified protein derivative (PPD) skin test. Thereafter, (January 1, 1993-December 31, 1996) all EMS health care workers who had negative PPD skin test results received annual tuberculin PPD skin tests. Tuberculin skin test conversion was defined as induration of 10 mm or greater in a worker with a documented prior negative test result. The PPD skin test reaction was measured by trained professional readers.
A total of 7,290 PPD test results were read during this study. Compliance with annual testing was 75%. Annual tuberculin skin test conversion rates were 1.3% in 1993, .7% in 1994, .1% in 1995, and .2% in 1996 (average .5%). In a static subgroup with at least 15 years' seniority, compliance with annual testing was 100% and annual tuberculin skin test conversion rates were .5% in 1993, 0 in 1994, .5% in 1995, and 1.5% in 1996 (average .6%).
Despite the high prevalence of M tuberculosis infection in New York City and the potential for difficulty in the use of respiratory precautions during emergency response operations, EMS prehospital health care workers have an annual tuberculin conversion rate that is relatively low compared with hospital-based health care workers.
确定在结核分枝杆菌高流行的城市环境中，院前医护人员（急救医疗技术员和护理人员）的年度结核菌素皮肤试验阳转（感染）率。
我们对纽约市紧急医疗服务（EMS）、EMS员工健康服务部门以及消防部门卫生服务局的院前医护人员进行了一项前瞻性研究，以确定结核菌素皮肤试验阳转率。1992年，所有既往无结核菌素反应阳性史的在职和新入职的EMS院前医护人员接受了基线结核菌素纯蛋白衍生物（PPD）皮肤试验。此后，（1993年1月1日至1996年12月31日）所有PPD皮肤试验结果为阴性的EMS医护人员每年接受结核菌素PPD皮肤试验。结核菌素皮肤试验阳转定义为先前记录的试验结果为阴性的工作人员硬结直径达到10毫米或更大。PPD皮肤试验反应由经过培训的专业人员读取。
在本研究期间共读取了7290份PPD试验结果。年度检测的依从率为75%。1993年的年度结核菌素皮肤试验阳转率为1.3%，1994年为0.7%，1995年为0.1%，1996年为0.2%（平均0.5%）。在一个至少有15年工作资历的固定亚组中，年度检测的依从率为100%，1993年的年度结核菌素皮肤试验阳转率为0.5%，1994年为0，1995年为0.5%，1996年为1.5%（平均0.6%）。
尽管纽约市结核分枝杆菌感染率很高，且在应急操作过程中使用呼吸道防护措施可能存在困难，但与医院医护人员相比，EMS院前医护人员的年度结核菌素阳转率相对较低。
