Risk of tuberculin conversion among healthcare workers and the adoption of preventive measures
Risk of tuberculin conversion among healthcare workers and the adoption of preventive measures
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DOI：
10.1136/oem.2006.028068
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发表时间：
2007-03-01
影响因子：
4.9
通讯作者：
Arossa, Walter
中科院分区：
文献类型：
--
作者：
Baussano, Iacopo;Bugiani, Massimiliano;Arossa, Walter
背景：在工业化国家，卫生保健工作者（HCWs）中的职业性结核病正在重新成为一个重要的公共卫生问题。为预防和控制结核病传播，一些机构发布并实施了建议和实践指南。目的：估计意大利皮埃蒙特地区首府都灵卫生保健员的结核病年感染率（ARTI；每100人年），以确定与ARTI变化相关的因素，并评估区域指南预防和控制结核病的有效性。方法：本研究于1997年至2004年对一组健康护理人员进行。通过结核菌素皮肤试验（TST）转换诊断结核感染，并定义为与先前TST阴性相比硬化增加至少10mm。每个高危亚组的ARTI和风险比（根据工作活动和环境进行分类）使用指数生存模型进行估计。根据指南实施的时刻（之前/之后）进行分层分析，估计区域指南的有效性。结果：2182名研究参与者来自动态队列。总体调整后的ARTI为1.6 (95% Cl: 1.3 ~ 1.9)/100人年。不同的工作场所（例如行政和传染病住院服务）和职业（例如文书和医务工作者）与显著不同的ARTIs相关，分别在0.62至2.62之间和0.61至1.71之间，而TST转换风险分别相差约16-68%和30-60%。准则的实施与ARTI总体减少1.3/100人年同时，不同职业和工作场所之间的ARTI差异消失了。结论：明确了卫生保健工作者结核病传播监测和预防工作的职业风险类别，采取预防措施可有效降低卫生保健工作者结核病感染的总体风险。
Background: In industrialised countries, occupational tuberculosis among healthcare workers (HCWs) is reemerging as an important public health issue. To prevent and control tuberculosis transmission, several institutions have issued and implemented recommendations and practice guidelines.Objectives: To estimate the annual rate of tuberculosis infection (ARTI; per 100 person-years) among HCWs in Turin, the capital of the Piedmont region of Italy, to identify factors associated with variations in the ARTI and to evaluate the efficacy of the regional guidelines to prevent and control tuberculosis.Methods: The study was conducted between 1997 and 2004 on a cohort of HCWs. The tuberculosis infection was diagnosed through tuberculin skin testing (TST) conversion and defined as an induration increase of at least 10 mm from a previous negative TST. The ARTI and the hazard ratio for each at-risk subgroup, categorised according to working activities and settings, was estimated using exponential survival models. The efficacy of the regional guidelines was estimated by stratifying the analysis according to the moment of the implementation of the guidelines (before/after).Results: The 2182 study participants were drawn from the dynamic cohort. The overall adjusted ARTI was 1.6 (95% Cl: 1.3 to 1.9)/100 person-years. Different workplaces (eg, administrative and infectious diseases inpatient services) and occupations (eg, clerical and medical workers) were associated with significantly different ARTIs, ranging between 0.62 and 2.62 and between 0.61 and 1.71, respectively, whereas the TST conversion risk differed by about 16-68% and 30-60%, respectively. The implementation of the guidelines coincided with overall ARTI reductions of 1.3/100 person-years, and concurrently the variations between ARTIs of different occupations and workplaces disappeared.Conclusions: The occupational risk categories for targeting the surveillance and prevention of tuberculosis transmission among HCWs were identified, and the introduction of preventive measures was observed to be effective in decreasing the overall risk of tuberculosis infection among HCWs.