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Evaluation of Infection Control Measures in Preventing the Nosocomial Transmission of Multidrug-Resistant Mycobacterium tuberculosis in a New York City Hospital

Published online by Cambridge University Press:  02 January 2015

Leonardo A. Stroud ,
Jerome I. Tokars ,
Michael H. Grieco ,
Jack T. Crawford ,
David H. Culver ,
Brian R. Edlin ,
Emilia M. Sordillo ,
Charles L. Woodley ,
Mary Ellen Gilligan  and
Nancy Schneider
...Show all authors
Leonardo A. Stroud
Affiliation:
Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia
Jerome I. Tokars*
Affiliation:
Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia
Michael H. Grieco
Affiliation:
St. Luke's-Roosevelt Hospital, New York, New York
Jack T. Crawford
Affiliation:
Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
David H. Culver
Affiliation:
Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia
Brian R. Edlin
Affiliation:
Division of HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia
Emilia M. Sordillo
Affiliation:
St. Luke's-Roosevelt Hospital, New York, New York
Charles L. Woodley
Affiliation:
Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Mary Ellen Gilligan
Affiliation:
St. Luke's-Roosevelt Hospital, New York, New York
Nancy Schneider
Affiliation:
St. Luke's-Roosevelt Hospital, New York, New York
Julie Williams
Affiliation:
St. Luke's-Roosevelt Hospital, New York, New York
William R. Jarvis
Affiliation:
Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Hospital Infections Program, Centers for Disease Control, Mailstop E-69, Atlanta, GA 30033
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Abstract

Objective:

To evaluate the efficacy of Centers for Disease Control and Prevention (CDC)-recommended infection control measures implemented in response to an outbreak of multidrug-resistant (MDR) tuberculosis (TB).

Design:

Retrospective cohort studies of acquired immunodeficiency syndrome (AIDS) patients and healthcare workers. The study period (January 1989 through September 1992) was divided into period I, before changes in infection control; period II, after aggressive use of administrative controls (eg, rapid placement of TB patients or suspected TB patients in single-patient rooms); and period III, while engineering changes were made (eg, improving ventilation in TB isolation rooms).

Setting:

A New York City hospital that was the site of one of the first reported outbreaks of MDR-TB among AIDS patients in the United States.

Participants:

All AIDS patients admitted during periods I and II. Healthcare workers on nine inpatient units with TB patients and six without TB patients.

Results:

The epidemic (38 patients) waned during period II and only one MDR-TB patient presented during period III. The MDR-TB attack rate among AIDS patients hospitalized on the same ward on the same days as an infectious MDR-TB patient was 8.8% (19 of 216) during period I, decreasing to 2.6% (5 of 193; P= 0.01) during period II. In a small group of healthcare workers with tuberculin skin test data, conversions during periods II through III were higher on wards with than without TB patients (5 of 29 versus 0 of 15; P= 0.15), although the difference was not statistically significant.

Conclusions:

Transmission of MDR-TB among AIDS patients decreased markedly after enforcement of readily implementable administrative measures, ending the outbreak. However, tuberculin skin-test conversions among healthcare workers may not have been prevented by these measures. CDC guidelines for prevention of nosocomial transmission of TB should be implemented fully at all US hospitals.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 16 , Issue 3 , March 1995 , pp. 141 - 147
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1995

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