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Tuberculosis Surveillance Practices in Long-Term Care Institutions

Published online by Cambridge University Press:  02 January 2015

Gary Naglie ,
Margaret McArthur ,
Andrew Simor ,
Monika Naus ,
Angela Cheung  and
Allison McGeer
Gary Naglie*
Affiliation:
Department of Medicine, The Toronto Hospital University of Toronto, Toronto, Ontario, Canada
Margaret McArthur
Affiliation:
Department of Microbiology, Princess Margaret and Mount Sinai Hospitals
Andrew Simor
Affiliation:
Departments of Microbiology and Medicine, Sunnybrook Health Science Centre and Baycrest Centre for Geriatric Care
Monika Naus
Affiliation:
Ontario Ministry of Health, Public Health Branch University of Toronto, Toronto, Ontario, Canada
Angela Cheung
Affiliation:
Department of Medicine, Deaconess Hospital, Boston, Massachusetts
Allison McGeer
Affiliation:
Department of Microbiology, Princess Margaret and Mount Sinai Hospitals University of Toronto, Toronto, Ontario, Canada
*
The Toronto Hospital, 200 Elizabeth St., EN G-238, Toronto, Ontario, CanadaM5G 2C4
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Abstract

Objecitves:

To identify the tuberculosis (TB) skin-testing practices of long-term care facilities for the elderly in Toronto, Ontario.

Design:

A telephone survey using a 25-item questionnaire.

Setting:

Twenty-nine nursing homes (NHs) and 26 Homes for the Aged (HFAs) in metropolitan Toronto.

Results:

Thirty-one percent of facilities (17 of 55) had no formal tuberculin skin-testing program, including 52% of NHs (15 of 29) versus 8% of HFAs (2 of 26; P= 0.001). Ninety-two percent of HFAs (24 of 26) compared with 45% of NHs (13 of 29), obtained preadmission or admission skin-test status of residents (P= 0.0005). Annual testing was performed at 46% of HFAs (12 of 26) and 27% of NHs (8 of 29; P= 0.28). Of facilities that carried out any skin testing, 64% of HFAs (16 of 25) versus 32% of NHs (6 of 19) measured induration to establish test positivity (P=0.068). Fifty-two percent of HFAs (13 of 25), compared with 21% of NHs (4 of 19), recorded the actual size of induration in the patient record (P=0.085). Only 28% of HFAs (7 of 25) and 21% of NHs (4 of 19) correctly defined a positive tuberculin skin test.

Conclusions:

TB surveillance practices in long-term care institutions in Toronto are inadequate and often yield results that do not predict the risk of infection and cannot be used to investigate outbreaks. Tuberculin skin-testing practices were better at HFAs, which are subject to provincial legislation regarding TB surveillance, than at NHs, which are not subject to this legislation. Staff at HFAs and NHs require education regarding tuberculin skin-testing policies and procedures.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 16 , Issue 3 , March 1995 , pp. 148 - 151
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1995

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References

1. Rieder, HL, Cauthen, GM, Kelly, GD, Bloch, AB, Snider, DE. Tuberculosis in the United States. JAMA 1989;262:385–389.CrossRefGoogle ScholarPubMed
2. Styblo, K, Rouillon, A. Tuberculosis in the world II: estimated global incidence of smear positive pulmonary tuberculosis. Bull Int Union Tuberc Lung Dis 1981;56:118–126.Google Scholar
3. Centers for Disease Control. A strategic plan for the elimination of tuberculosis in the United States. MMWR 1989;38(S-3):1–25.Google Scholar
4. Yoshikawa, TT. Elimination of tuberculosis from the United States. J Am Geriatr Soc 1991;39:312–314.10.1111/j.1532-5415.1991.tb01656.xCrossRefGoogle ScholarPubMed
5. Centers for Disease Control. Summary of notifiable diseases, United States 1992. MMWR 1993;41:10.Google Scholar
6. Stead, WW, Lofgren, JP. Medical perspective: does the risk of tuberculosis increase in old age? J Infect Dis 1983;147:951–955.CrossRefGoogle Scholar
7. Stead, WW, Lofgren, JP Warren, E, Thomas, C. Tuberculosis as an endemic and nosocomial infection among the elderly in nursing homes. N Engl J Med 1985;312:1483–1487.CrossRefGoogle ScholarPubMed
8. Stead, WW. Why does tuberculosis remain so common among the elderly? Hosp Pract 1987;22:9–10.Google Scholar
9. Centers for Disease Control. Prevention and control of tuberculosis in facilities providing long-term care to the elderly. MMWR 1990;39(RR-10):7–20.Google Scholar
10. Stead, WW, To, T. The significance of the tuberculin skin test in elderly persons. Ann Intern Med 1987;107:837–842.Google Scholar
11. Davidson, PT, Tuberculosis: new views of an old disease. N Engl J Med 1985;312:1514–1515.CrossRefGoogle ScholarPubMed
12. Brennen, C, Muder, RR, Muraca, PW. Occult endemic tuberculosis in a long-term care facility. Infect Control Hosp Epidemiol 1988;9:548–552.CrossRefGoogle Scholar
13. Government of Canada, Bureau of Communicable Disease Epidemiology, Health Protection Branch and Health Services Directorate, Health Services and Promotion Branch. Infection Control Guidelines for Long Term Care Facilities. Ministry of National Health and Welfare, Canada; 1986:21.Google Scholar
14. Government of Ontario, Ministry of the Attorney General. Homes for the Aged and Rest Homes Act: Regulation 502. Queen's Printer for Ontario; 1989::45–46.Google Scholar
15. Colton, T: Statistics in Medicine. Boston, MA: Little, Brown and Co; 1974::174–177.Google Scholar
16. Stead, WW, Tuberculosis among elderly persons: an outbreak in a nursing home. Ann Intern Med 1981:94:606–610.Google Scholar
17. Rosenberg, T, Manfreda, J, MacMorran, J, Bennet, B, Hershfield, E. The booster response in staff and residents in a Canadian nursing home. Am Rev Respir Dis 1992; 145:A104.Google Scholar
18. McDonald, RJ, Mulvihill, MN, Hsu, MA, Libow, LS, Neufeld, RR. Tuberculosis surveillance in a long-term care facility. Arch Gerontol Geriatr 1992;15:29–34.Google Scholar
19. Price, LE, Rutala, WA. Tuberculosis screening in the long-term care setting. Infect Control 1987;8:353–356.CrossRefGoogle ScholarPubMed