Nosocomial Tuberculosis: An Outbreak of a Strain Resistant to Seven Drugs

1995 ◽  
Vol 16 (3) ◽  
pp. 152-159
Author(s):  
Robin M. Ikeda ◽  
Guthrie S. Birkhead ◽  
George T. DiFerdinando ◽  
Donald L. Bornstein ◽  
Samuel W. Dooley ◽  
...  
Keyword(s):  
New York ◽  
Infection Control ◽  
Skin Test ◽  
Exposure Period ◽  
Multidrug Resistant ◽  
Correctional Officer ◽  
Direct Care ◽  
Nosocomial Transmission ◽  
Environmental Controls ◽  
Mdr Tb

AbstractObjective:To evaluate nosocomial transmission of multidrug-resistant (MDR) tuberculosis (TB).Design:Outbreak investigation: review of infection control practices and skin test results of healthcare workers (HCWs); medical records of hospitalized TB patients and mycobacteriology reports; submission of specimens for restriction fragment length polymorphism (RFLP) typing; and an assessment of the air-handling system.Setting:A teaching hospital in upstate New York.Results:Skin-test conversions occurred among 46 (6.6%) of 696 HCWs tested from August through October 1991. Rates were highest on two units (29% and 20%); HCWs primarily assigned to these units had a higher risk for conversion compared with HCWs tested following previous incidents of exposure to TB (relative risk [RR] = 53.4, 95% confidence interval [CI95] =6.9 to 411.1; and RR=37.4, CI95= 5.0 to 277.3, respectively). The likely source patient was the only TB patient hospitalized on both units during the probable exposure period. This patient appeared clinically infectious, was associated with a higher risk of conversion among HCWs providing direct care (RR = 2.37; CI95 = 1.05 to 5.34), and was a prison inmate with TB resistant to seven antituberculosis agents. The MDR-TB strain isolated from this patient also was isolated from other inmate and noninmate patients, and a prison correctional officer exposed in the hospital. Mycobacterium tuberculosis isolates from all of these patients had matching RFLP patterns. Infection control practices closely followed established guidelines; however, several rooms housing TB patients had marginal negative pressure with variable numbers of air changes per hour, and directional airflow was disrupted easily.Conclusions:These data strongly suggest nosocomial transmission of MDR-TB to HCWs, patients, and a prison correctional officer working in the hospital. Factors contributing to transmission apparently included prolonged infectiousness of the likely source patient and inadequate environmental controls. Continued urgent attention to TB infection control is needed.

Transmission of Multidrug-Resistant Mycobacterium tuberculosis Among Persons Exposed in a Medical Examiner's Office, New York

1995 ◽  
Vol 16 (3) ◽  
pp. 160-165
Author(s):  
Xilla T. Ussery ◽  
Jennifer A. Bierman ◽  
Sarah E. Valway ◽  
Teresa A. Seitz ◽  
George T. DiFerdinando ◽  
...  
Keyword(s):  
New York ◽  
Mycobacterium Tuberculosis ◽  
Skin Testing ◽  
Multidrug Resistant ◽  
Positive Tuberculin Skin Test ◽  
Positive Pressure ◽  
Tuberculin Skin Testing ◽  
Environmental Investigation ◽  
Environmental Controls ◽  
Mdr Tb

AbstractObjective:To determine the prevalence of and risk factors for having a positive tuberculin skin test (TST) result among employees at a medical examiner's office (MEO).Design:Cohort study, environmental investigation.Setting:Several employees at a medical examiner's office were found to have positive TST results after autopsies were performed on persons with multidrug-resistant tuberculosis (MDR-TB).Participants:Employees of the MEO.Results:Of 18 MEO employees, 5 (28%) had a positive TST result; 2 of these 5 had TST conversions. We observed a trend between TST conversion and participation in autopsies on persons with MDR-TB (2 of 2 converters versus 3 of 13 employees with negative TST; relative risk=4.3; 95% confidence interval 1.61 to 11.69; P=0.l0). The environmental investigation revealed that the autopsy room was at positive pressure relative to the rest of the MEO and that air from the autopsy room mixed throughout the facility.Conclusions:A systematic approach to preventing transmission of Mycobacterium tuberculosis in autopsy suites should include effective environmental controls and routine tuberculin skin testing of employees.

Evaluation of Infection Control Measures in Preventing the Nosocomial Transmission of Multidrug-Resistant Mycobacterium tuberculosis in a New York City Hospital

1995 ◽  
Vol 16 (3) ◽  
pp. 141-147
Author(s):  
Leonardo A. Stroud ◽  
Jerome I. Tokars ◽  
Michael H. Grieco ◽  
Jack T. Crawford ◽  
David H. Culver ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
Infection Control ◽  
Healthcare Workers ◽  
Multidrug Resistant ◽  
Control Measures ◽  
City Hospital ◽  
Aids Patients ◽  
Infection Control Measures ◽  
Mdr Tb

AbstractObjective:To evaluate the efficacy of Centers for Disease Control and Prevention (CDC)-recommended infection control measures implemented in response to an outbreak of multidrug-resistant (MDR) tuberculosis (TB).Design:Retrospective cohort studies of acquired immunodeficiency syndrome (AIDS) patients and healthcare workers. The study period (January 1989 through September 1992) was divided into period I, before changes in infection control; period II, after aggressive use of administrative controls (eg, rapid placement of TB patients or suspected TB patients in single-patient rooms); and period III, while engineering changes were made (eg, improving ventilation in TB isolation rooms).Setting:A New York City hospital that was the site of one of the first reported outbreaks of MDR-TB among AIDS patients in the United States.Participants:All AIDS patients admitted during periods I and II. Healthcare workers on nine inpatient units with TB patients and six without TB patients.Results:The epidemic (38 patients) waned during period II and only one MDR-TB patient presented during period III. The MDR-TB attack rate among AIDS patients hospitalized on the same ward on the same days as an infectious MDR-TB patient was 8.8% (19 of 216) during period I, decreasing to 2.6% (5 of 193; P= 0.01) during period II. In a small group of healthcare workers with tuberculin skin test data, conversions during periods II through III were higher on wards with than without TB patients (5 of 29 versus 0 of 15; P= 0.15), although the difference was not statistically significant.Conclusions:Transmission of MDR-TB among AIDS patients decreased markedly after enforcement of readily implementable administrative measures, ending the outbreak. However, tuberculin skin-test conversions among healthcare workers may not have been prevented by these measures. CDC guidelines for prevention of nosocomial transmission of TB should be implemented fully at all US hospitals.

Adverse events and development of tuberculosis after 4 months of rifampicin prophylaxis in a tuberculosis outbreak

2011 ◽  
Vol 140 (6) ◽  
pp. 1028-1035 ◽  
Author(s):  
S. H. LEE ◽  
J.-J. YIM ◽  
H. J. KIM ◽  
T. S. SHIM ◽  
H. S. SEO ◽  
...  
Keyword(s):  
Adverse Events ◽  
Tuberculin Skin Test ◽  
Skin Test ◽  
Interferon Gamma ◽  
Multidrug Resistant ◽  
Outbreak Investigation ◽  
Interferon Gamma Release Assay ◽  
Mdr Tb ◽  
Release Assay

SUMMARYWe screened tuberculosis (TB) contacts as an outbreak investigation with tuberculin skin test (TST) and interferon-gamma release assay (IGRA). We evaluated adverse events and TB incidence in all persons screened after rifampicin (RFP) prophylaxis, and specifically assessed the new TB cases in relation to initial TST and IGRA results. The 180 contacts were divided into four groups: TST+/IGRA+ (n=101), TST+/IGRA− (n=22), TST−/IGRA+ (n=16), and TST–/IGRA– (n=41). RFP treatment (4 months) was prescribed only to the TST+/IGRA+ group. Of 87 contacts who initiated prophylaxis, adverse events occurred in 21 contacts (24·1%) including hepatotoxicity (11·5%), flu-like syndrome (5·7%), and thrombocytopenia (3·4%). TB developed in two TST+/IGRA+ subjects after completion of prophylaxis, including one multidrug-resistant (MDR)-TB case during 21·8 months of follow-up. Adverse events were frequent, and development of TB including MDR-TB occurred after RFP prophylaxis.

Use and Efficacy of Tuberculosis Infection Control Practices at Hospitals With Previous Outbreaks of Multidrug-Resistant Tuberculosis

2001 ◽  
Vol 22 (7) ◽  
pp. 449-455 ◽  
Author(s):  
Jerome I. Tokars ◽  
George F. McKinley ◽  
Joan Otten ◽  
Charles Woodley ◽  
Emilia M. Sordillo ◽  
...  
Keyword(s):  
Infection Control ◽  
Tuberculin Skin Test ◽  
Skin Test ◽  
Healthcare Workers ◽  
Multidrug Resistant ◽  
Test Results ◽  
Genetic Typing ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Number Of Patients

AbstractObjective:To evaluate the implementation and efficacy of selected Centers for Disease Control and Prevention guidelines for preventing spread ofMycobacterium tuberculosis.Design:Analysis of prospective observational data.Setting:Two medical centers where outbreaks of multidrug-resistant tuberculosis (TB) had occurred.Participants:All hospital inpatients who had active TB or who were placed in TB isolation and healthcare workers who were assigned to selected wards on which TB patients were treated.Methods:During 1995 to 1997, study personnel prospectively recorded information on patients who had TB or were in TB isolation, performed observations of TB isolation rooms, and recorded tuberculin skin-test results of healthcare workers. Genetic typing ofM tuberculosisisolates was performed by restriction fragment-length polymorphism analysis.Results:We found that only 8.6% of patients placed in TB isolation proved to have TB; yet, 19% of patients with pulmonary TB were not isolated on the first day of hospital admission. Specimens were ordered for acid-fast bacillus smear and results received promptly, and most TB isolation rooms were under negative pressure. Among persons entering TB isolation rooms, 44.2% to 97.1% used an appropriate (particulate, high-efficiency particulate air or N95) respirator, depending on the hospital and year; others entering the rooms used a surgical mask or nothing. We did not find evidence of transmission of TB among healthcare workers (based on tuberculin skin-test results) or patients (based on epidemiological investigation and genetic typing).Conclusions:We found problems in implementation of some TB infection control measures, but no evidence of healthcare-associated transmission, possibly in part because of limitations in the number of patients and workers studied. Similar evaluations should be performed at hospitals treating TB patients to find inadequacies and guide improvements in infection control.

SHEA-CDC TB Survey, Part I: Status of TB Infection Control Programs at Member Hospitals, 1989-1992

1995 ◽  
Vol 16 (3) ◽  
pp. 129-134
Author(s):  
Scott K. Fridkin ◽  
Lilia Manangan ◽  
Elizabeth Bolyard ◽  
William R. Jarvis ◽  
Keyword(s):  
Infection Control ◽  
Healthcare Workers ◽  
Skin Testing ◽  
Multidrug Resistant ◽  
Control Measures ◽  
Tuberculin Skin Testing ◽  
Respiratory Protection ◽  
Mdr Tb ◽  
Reported Data ◽  
Tb Infection Control

AbstractObjective:To determine trends in Mycobacterium tuberculosis infection in healthcare workers, tuberculosis (TB) control measures, and compliance with the 1990 Centers for Disease Control and Prevention (CDC) guideline for preventing transmission of TB in healthcare facilities.Design:Voluntary questionnaire sent to all members of the Society for Healthcare Epidemiology of America, representing 359 hospitals.Results:Respondents’ hospitals (210 [58%]) had a median of 2,400 healthcare workers (range, 396 to 13,745), 437 beds (range, 48 to 1,250), 5.6 patients with TB per year (range, 0 to 492), and 0 multidrug-resistant (MDR) TB patients per year (range, 0 to 33). Of 166 respondents’ hospitals for which data were provided for 1989 through 1992, the number caring for MDR-TB patients increased from 10 (6%) in 1989 to 49 (30%) in 1992. Reported policies for routine healthcare worker tuberculin skin testing varied. The median skin-test positivity rate for healthcare workers at the time of hire increased from 0.54% in 1989 to 0.81% in 1992, but the median conversion rate during routine testing remained similar: 0.35% in 1989 and 0.33% in 1992. Among 196 hospitals with reported data on respiratory protection use for 1989 through 1992, the use of either surgical submicron, dust-mist, or dust-fume-mist respirators for healthcare workers increased from 9 (5%) in 1989 to 85 (43%) in 1992. Of 181 hospitals with reported data, 113 (62%) had acid-fast bacilli isolation facilities consistent with the 1990 CDC guideline (ie, a single patient room, negative air pressure relative to the hallway, air exhausted directly outside, and ≥ 6 air exchanges per hour).Conclusions:While the number of surveyed hospitals caring for TB and MDR-TB patients increased during 1989 through 1992, TB infection control measures at many hospitals still did not meet the 1990 CDC guideline recommendations.

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