PREVENTING THE NOSOCOMIAL TRANSMISSION OF TUBERCULOSIS
PREVENTING THE NOSOCOMIAL TRANSMISSION OF TUBERCULOSIS
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DOI：
10.7326/0003-4819-122-9-199505010-00003
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发表时间：
1995-05-01
影响因子：
39.2
通讯作者：
MCGOWAN, JE
中科院分区：
文献类型：
--
作者：
BLUMBERG, HM;WATKINS, DL;MCGOWAN, JE
目的：研究主要由行政控制组成的扩大结核病感染控制措施的有效性。设计：描述性病例系列。设置：大学附属，市中心医院。干预措施：引入扩大结核病感染控制措施（包括扩大呼吸隔离政策）。在实施扩大感染控制措施之前和之后，测量了医护人员的结核病暴露次数和皮试转换率。结核病暴露事件（入院时未进行呼吸道隔离，但随后在入院期间或出院后2周内诊断为抗酸杆菌涂片阳性肺结核的患者数量）在两个时间段进行比较：实施感染控制措施前8个月和实施感染控制措施后28个月。在2.5年的时间里，对卫生保健工作者中的阿曲库林皮肤试验转换率进行了评估。在实施扩大的感染控制措施后，肺结核感染病例从每月4.4例减少到（8个月内因潜在传染性结核病入院的103名患者中有35例发病）至每月0.6例（358例因涂阳肺结核住院28个月以上的患者中有18例发病）（比值比，9.72，95% CI，4.99 ~ 19.25 [P < 0.001]）。潜在传染性肺结核病人未隔离的月累计天数由35.4天减少到3.3天（P < 0.001）。医护人员的结核菌素皮试转换率也随之下降; 6个月结核菌素皮试转换率从3.3%（3579名医护人员中有118名转换; 1/92至6/92）、1.7%、1.4%、0.6%至0.4%结论：采取有效的感染控制措施，可有效地预防结核病在医务人员中的院内传播。行政控制似乎是结核病感染控制计划的最重要组成部分，应该是这样一个计划的第一个重点，特别是在公立医院，那里的资源是最有可能是有限的。
Objective: To study the efficacy of expanded tuberculosis infection control measures consisting primarily of administrative controls.Design: Descriptive case series.Setting: University-affiliated, inner-city hospital.Interventions: Introduction of expanded tuberculosis infection control measures (including an expanded respiratory isolation policy).Measurements: The number of tuberculosis exposure episodes and skin test conversion rates of health care workers were measured before and after implementation of expanded infection control measures. Tuberculosis exposure episodes (the number of patients who were not placed in respiratory isolation at admission but who subsequently had a diagnosis of acid-fast bacilli smear-positive pulmonary tuberculosis during that admission or within 2 weeks of discharge) were compared for two time periods: the 8 months before and the 28 months after implementation of infection control measures. Tuberculin skin test conversion rates among health care workers were evaluated during a 2.5-year period.Results: After expanded infection control measures were implemented, the number of tuberculosis exposure episodes decreased from 4.4 per month (35 episodes among 103 patient admissions for potentially infectious tuberculosis over 8 months) to 0.6 per month (18 episodes among 358 patient admissions for smear-positive pulmonary tuberculosis over 28 months) (odds ratio, 9.72; 95% CI, 4.99 to 19.25 [P < 0.001]). The cumulative number of days per month that potentially infectious patients with tuberculosis were not in isolation decreased from 35.4 to 3.3 (P < 0.001). A concomitant decrease in tuberculin skin test conversion rates in health care workers was seen; 6-month tuberculin skin test conversion rates decreased steadily from 3.3% (118 conversions in 3579 health care workers; 1/92 to 6/92), 1.7%, 1.4%, 0.6%, to 0.4% (23 conversions in 5153 workers [1/94 to 6/94]) (P < 0.001).Conclusions: Infection control measures effectively prevented nosocomial transmission of tuberculosis to health care workers. Administrative controls appear to be the most important component of a tuberculosis infection control program and should be the first focus of such a program, especially at public hospitals, where resources are most likely to be limited.