Nosocomial transmission of tuberculosis in a hospital unit for HIV-infected patients
S. W. Dooley, M. E. Villarino, M. Lawrence, L. Salinas, S. Amil, J. V. Rullan, W. R. Jarvis, A. B. Bloch and G. M. Cauthen
Division of Tuberculosis Elimination, National Center for Infectious Diseases, Centers for Disease Control, Atlanta, GA 30333.
OBJECTIVE--To assess nosocomial transmission of tuberculosis (TB).
DESIGN--A historical cohort study of hospitalized patients with the human
immunodeficiency virus (HIV) and a purified protein derivative (PPD)
tuberculin skin test survey of health care workers (HCWs). SETTING--A large
public teaching hospital in San Juan, Puerto Rico. PATIENTS--For the cohort
study, a case patient was defined as any patient in the HIV unit at the
hospital who developed culture-positive TB from 31 days or more after
admission through December 31, 1989. For the PPD survey, of 1420 HCWs from
the hospital, 908 agreed to participate and had sufficient data for
analysis. MAIN OUTCOME MEASURES--For the cohort study, to compare the risk
of developing active TB among patients who were exposed to hospital
roommates with infectious TB and the risk among nonexposed patients. For
the HCW PPD survey, to determine the prevalence of and risk factors for
tuberculous infection. RESULTS--Eight of 48 (9.7/10,000 person-days)
exposed case patients vs four of 192 (0.8/10,000 person-days) nonexposed
case patients developed active TB (relative risk [RR] = 11; 95% confidence
interval [CI], 2.3, 50.3). Positive PPDs (greater than or equal to 10 mm of
induration) in HCWs were associated with older age (P = .0001) and with
history of community TB exposure (P = .0002). In a multivariable logistic
model that adjusted for these variables, HIV unit nurses (nine of 19) and
nurses in the internal medicine ward (45 of 90) had a higher proportion of
positive PPDs than the reference group (clerical personnel on other floors:
35 of 188, P = .0005). CONCLUSIONS--These data suggest that
patient-to-patient transmission of TB in HIV units can occur and that HCWs
are at risk of acquiring TB infection.
American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: Controlling Tuberculosis in the United States
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