Hospital ventilation and risk for tuberculous infection in Canadian health care workers
Hospital ventilation and risk for tuberculous infection in Canadian health care workers
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DOI：
10.7326/0003-4819-133-10-200011210-00010
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发表时间：
2000-11-21
影响因子：
39.2
通讯作者：
FitzGerald, JM
中科院分区：
文献类型：
--
作者：
Menzies, D;Fanning, A;FitzGerald, JM
背景资料：结核病的风险和决定因素的传播，在医院照顾中等数量的结核病患者仍然不确定。目的：研究结核菌素转换与病人护理区通风的卫生保健工作者之间的关联。设计：横断面观察调查。设置：17个急性护理社区或大学医院。参与者：在呼吸科和理疗科或选定的护理units.Measurements：参与工人进行结核菌素皮肤试验，并完成自我管理的问卷调查，每周至少工作2天的所有人员。以前的结核菌素试验和卡介苗接种得到证实。回顾了研究前3年内住院的结核病患者的记录。使用示踪气体技术测量患者护理区域每小时的空气交换量。多变量比例风险回归用于估计职业因素对记录的结核菌素转换的影响，在调整非职业因素后，参与者至少有一个以前的结核菌素皮肤试验阴性结果。普通病房或非隔离病房每小时换气少于2次，（调整后的风险比，3.4 [95% CI，2.1 - 5.8]）;在中高风险医院工作（校正的风险比，2.2 [Cl，1.3 - 3.5]）;在护理工作中（校正的风险比，4.3 [Cl，2.7 - 6.91]），呼吸治疗（校正的风险比，6.1 [Cl，3.1 - 12.0]）和物理治疗（校正的风险比，3.3 [Cl，1.5 - 74]）部门或家政（校正的风险比，4.2 [Cl，2.3 - 7.6]）。转换与呼吸隔离室的通风不足无关（调整后的风险比，1.0 [Cl，0.8至1.3）。结论：在卫生保健工作者中，沙丁胺醇转换与普通病房的通风不足以及工作类型和持续时间密切相关，但与呼吸隔离室的通风无关。
Background: The risk for and determinants of transmission of tuberculosis in hospitals caring for moderate numbers of patients with tuberculosis remain uncertain.Objective: To study the association of tuberculin conversion among health care workers with ventilation of patient care areas.Design: Cross-sectional observational survey.Setting: 17 acute-care community or university hospitals.Participants: All personnel who worked at least 2 days per week in the respiratory and physiotherapy departments or in selected nursing units.Measurements: Participating workers underwent tuberculin skin testing and completed self-administered questionnaires. Previous tuberculin tests and bacille Calmette-Guerin vaccinations were verified. Records of patients with tuberculosis who were hospitalized in the 3 years preceding the study were reviewed. Air exchanges per hour in patient care areas were measured by using a tracer gas technique. Multivariate proportional hazards regression was used to estimate the effect of occupational factors on documented tuberculin conversion, after adjustment for nonoccupational factors, among participants with at least one previous negative result on tuberculin skin testing.Results: Tuberculin conversion was associated with ventilation of general or nonisolation patient rooms of less than 2 air exchanges per hour (adjusted hazard ratio, 3.4 [95% Cl, 2.1 to 5.8]); with work in moderate- to high-risk hospitals (adjusted hazard ratio, 2.2 [Cl, 1.3 to 3.5]); and with work in the nursing (adjusted hazard ratio, 4.3 [Cl, 2.7 to 6.91), respiratory therapy (adjusted hazard ratio, 6.1 [Cl, 3.1 to 12.0]), and physiotherapy (adjusted hazard ratio, 3.3 [Cl, 1.5 to 74) departments or housekeeping (adjusted hazard ratio, 4.2 [Cl, 2.3 to 7.6]). Conversion was not associated with inadequate ventilation of respiratory isolation rooms (adjusted hazard ratio, 1.0 [Cl, 0.8 to 1.3).Conclusion: Tuberculin conversion among health care workers was strongly associated with inadequate ventilation in general patient rooms and with type and duration of work, but not with ventilation of respiratory isolation rooms.