Implementing tuberculosis control guidelines in a hospital environment.

Abstract

AIM: This review assessed the effectiveness and results of a programme implementing the 1992 Tuberculosis Control Guidelines to hospital staff at Green Lane and National Women's hospitals. METHODS: All staff tuberculosis surveillance and patient contact tracing contacts carried out by the occupational health unit and the resultant outcomes were assessed. RESULTS: A higher risk of Mantoux conversion does exist in hospital staff. These conversions occur in nonhigh risk occupational groups as well as the more recognized at risk groups. CONCLUSIONS: The 1992 guidelines proved impracticable to administer effectively and were resource intensive. Hospital staff form a distinct, well educated occupational group who are able to make their own risk assessments about the lifetime risks of tuberculosis infection. The British Thoracic Society Guidelines for screening healthcare workers make a practical surveillance programme. Tuberculosis remains a risk for healthcare workers and the emphasis of any staff programme should broaden from surveillance aimed at identifying primary infection having occurred to include improved environmental measures, work practices and the use of personal protection to reduce the work related exposure to the mycobacterium.