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To determine if compliance with annual tuberculosis skin testing correlated with the number of cases of tuberculosis seen in patients and healthcare workers.
Survey using a written questionnaire.
Setting and Participants:
159 Veterans' Administration facilities.
Hospitals that reported that >80% of their healthcare workers received annual skin tests saw 12.7 patient cases per 10,000 admissions and 4.0 healthcare worker cases per 10,000 personnel. Facilities in which <20% of their healthcare workers were given annual skin tests saw 4.5 cases per 10,000 admissions and 1.6 cases in healthcare workers per 10,000 personnel (P<.001 for patients and P=.31 for healthcare workers). The ratio of the median number of patients placed in acid-fast bacilli (AFB) isolation to the median number of patients with confirmed tuberculosis was 12. There was no correlation of this ratio with the number of cases of tuberculosis in patients or healthcare workers seen in each facility.
Compliance with annual tuberculosis skin testing was related directly to the rate of tuberculosis seen in patients. More standardized policies for placing patients in AFB isolation are needed to control for potentially costly variation among facilities. These measures should have highest priority in the control of tuberculosis in the healthcare setting, before implementing still more expensive interventions.
To investigate trends in plasmid types of methicillin-resistant Staphylococcus aureus over a 3-year period and determine the clinical impact of plasmid typing.
Restriction endonuclease analysis of plasmid DNA (REAP) was used to type 270 clinical isolates.
A Veterans Affairs Medical Center.
Forty-four different REAP types were identified and, of these, 23 appeared only once. Types designed as V1 and V2 were more commonly found in nosocomial cases than in community-acquired cases (p<.05); whereas the K and D types were more common in isolates from community-acquired cases (<c.05). In 30 (11%) isolates, no plasmid was detected. When combined with epidemiological data, REAP typing revealed 4 small outbreaks that would have been missed using traditional epidemiological methods alone. In large outbreaks involving 10 or more cases, REAP typing data revealed unsuspected patterns of transmission.
Multiple plasmid types were present in this endemic setting. Restriction endonuclease analysis of plasmid DNA was a practical and valuable adjunct to traditional epidemiological methods.
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