Tuberculosis isolation: Comparison of written procedures and actual practices in three California hospitals
Tuberculosis isolation: Comparison of written procedures and actual practices in three California hospitals
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DOI：
10.1086/501693
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发表时间：
2000-01-01
影响因子：
4.5
通讯作者：
Harrison, RJ
中科院分区：
文献类型：
--
作者：
Sutton, PM;Nicas, M;Harrison, RJ
目的：根据疾病控制和预防中心(CDC)指南和医院的结核病控制政策，评估医务人员对结核病患者隔离的暴露控制措施的实施情况。设计：前瞻性多医院研究，比较CDC指南和医院政策对结核病患者隔离的前瞻性研究，以及对每家医院连续14周的结核病患者隔离做法的每周一次观察。结果：在观察到的170个结核病人病房中，119个(70%)病人在指定的TR隔离室内，房间负压，门紧闭，门上有“呼吸预防”标志；32个病房单元(19%)没有负压或未被指定为负压室。在151个机械上能够在以前的PC上及时负压的病房单元中，16个(11%)在使用时没有负压，在67个配备连续监测设备的病房单元中，8个(12%)的设备不能准确地反映气流的方向。在62名使用呼吸器治疗结核病的医护人员中，40人(65%)没有正确佩戴呼吸器。结论：在三家医院实施结核病患者隔离的CDC指南是可行的，但并不完善。日常工作做法背离了医院的政策。在房间使用期间对医院结核病隔离政策的实施进行前瞻性量化可能会改善对风险的估计，并可能有助于识别并从而防止医护人员暴露在可避免的结核分枝杆菌气雾剂中。审计实践和验证设备性能很可能发现结核病控制计划实施中的意外问题(传染病控制和流行病学2000年；21：2832)。
OBJECTIVE: To evaluate implementation of healthcare worker exposure control measures for tuberculosis (TB)-patient isolation, as specified by Centers for Disease Control and Prevention (CDC) guidelines and the hospital's TB-control policy.DESIGN: Prospective multihospital study comparing CDC guidelines and hospital policy for TB-patient isolation to once-weekly observations of TB-patient isolation practices over 14 consecutive weeks at each hospital.SETTING: Three urban hospitals (two county, one private community) in counties in California with a high incidence rate of TB.MEASUREMENTS: Work practices for TB-patient isolation were observed and ventilation performance of isolation rooms was assessed while patient rooms were in use for TB isolation.RESULTS: Of 170 TB-patient rooms observed, 119 (70%) involved a patient in a designated TR isolation room, the room was under negative pressure, the door was closed, and a "respiratory precautions" sign was on the door; 32 patient-room units (19%) were not under negative pressure or not designated as negative pressure rooms. Of 151 patient-room units mechanically capable of negative pressure at a prior pc,int in time, 16 (11%) were not under negative pressure at the time of use, Of 67 patient-room units equipped with continuous monitoring devices, 8 (12%) involved devices that did not accurately reflect the direction of airflow. Of the 62 healthcare workers observed using a respirator for TB, 40 (65%) did not don the respirator properly.CONCLUSIONS: Implementing CDC guidelines for TB patient isolation was feasible but imperfect in the three hospitals. Day-to-day work practices deviated from hospital policy. Prospectively quantifying the implementation of a hospital TB isolation policy while the room is in use may lead to improved estimates of risk and may help to identify and thereby prevent avoidable healthcare worker exposures to Mycobacterium tuberculosis aerosol. Auditing practices and verifying equipment performance is likely to identify unexpected problems in implementation of the TB control program (Infect Control Hosp Epidemiol 2000;21:2832).