Control of nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis among healthcare workers and HIV-infected patients

• Published in: The Lancet (British edition) 1995-01, Vol.345 (8944), p.235-240
• Main Authors: Wenger, P.N., Beck-Sague, C.M., Jarvis, W.R., Otten, J., Breeden, A., Orfas, D.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; AIDS-Related Opportunistic Infections - prevention & control; AIDS/HIV; Bacilli; Bacterial diseases; Biological and medical sciences; Cross Infection - prevention & control; Data Interpretation, Statistical; Disease control; Disease transmission; Disease Transmission, Infectious - prevention & control; Exposure; Female; Georgia; Guidelines; Health care; Health Personnel; HIV; Hospitals; Human bacterial diseases; Human immunodeficiency virus; Humans; Infection Control - methods; Infectious Disease Transmission, Patient-to-Professional - prevention & control; Infectious diseases; Male; Medical personnel; Medical research; Medical sciences; Middle Aged; Multidrug resistance; Multidrug resistant organisms; Nosocomial infection; Occupational exposure; Outbreaks; Patients; Prevention; Public health; Skin tests; Sputum; Tuberculin; Tuberculin Test; Tuberculosis; Tuberculosis and atypical mycobacterial infections; Tuberculosis, Multidrug-Resistant - diagnosis; Tuberculosis, Multidrug-Resistant - epidemiology; Tuberculosis, Multidrug-Resistant - prevention & control; Ultrasonic testing
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(95)90228-7

From 1988 to 1990, an outbreak of multidrug-resistant tuberculosis (MDR-TB) among patients, and an increased number of tuberculin-skin-test conversions among healthcare workers, occurred on the HIV ward of Jackson Memorial Hospital, Miami, Florida, USA. Measures similar to those subsequently recommended in the 1990 Centers for Disease Control and Prevention guidelines were implemented on the HIV ward by June, 1990, and in September, 1992, we evaluated the efficacy of these control measures. Among MDR-TB patients and healthcare workers with tuberculin-skin-test conversions on the HIV ward, we looked for evidence of exposure to HIV ward MDR-TB patients positive for acid-fast bacilli in sputum during initial (January-May, 1990) and follow-up (June, 1990-June, 1992) periods. Exposure before implementation of control measures to an infectious MDR-TB patient on the HIV ward was recorded in 12 of 15 (80%) MDR-TB patients during the initial period and 5 of 11 (45%) MDR-TB patients during follow-up. After implementation of control measures, no episodes of MDR-TB could be traced to contact with infectious MDR-TB patients on the HIV ward. Skin-test conversions among workers on the HIV ward declined from 7 of 25 (28%) during the initial period to 3 of 17 (18%) in the early (June, 1990-February, 1991) and 0 of 23 in the late (March, 1991-June, 1992) follow-up periods (p