Category: Tuberculosis

The PPD reactor rate of 12.8% for new employees was quite high compared with a mean initial reactor rate of 1.91% found in the SHEA-CDC survey. This high rate is likely attributable to two facts. First, TB is significantly more prevalent in San Diego than in the nation as a whole. Second, individuals at high risk for TB infection make up a significant number of UCSD’s employees and volunteers. These include foreign-born persons and members of racial and ethnic minorities. It should be noted that the high rate of reactors among new personnel does not contribute to the relatively low conversion rate among established employees seen at our institution. Once an individual has a PPD of 10 mm or more, he or she is not retested. Therefore, these individuals do not appear in the denominator (ie, total PPD tests for established employees) of the skin test conversion rate for established personnel. …Read the rest of this article

Effectiveness of a Nosocomial Tuberculosis Control Program at an Urban Teaching Hospital: INH Preventive TreatmentOf the 894 convertors and reactors, 259 (91 convertors, 167 reactors) were felt to be eligible for INH preventive treatment by the skin testing technical staff and were offered an appointment with a physician for evaluation (Table 4). Forty-two individuals (16.2%) did not attend their appointment despite repeated requests. Of those that did attend, only 169 (65.3% of all employees eligible to take INH) agreed to take INH. One hundred fifty-nine employees and volunteers who were started on INH were evaluable to determine completion of therapy. Seventy-seven (48.4%) completed at least 6 months of therapy. For those who did not finish treatment, the drug was stopped by the employee in the vast majority of cases. canadian health and care mall
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Sixty-six new personnel received a TB symptom questionnaire because it was decided that a chest radiograph should be deferred (Table 2). Only one individual (1.5%) responded positively to any of the questions. TB symptom questionnaires were given to 2,815 returning employees (either the employee was low-risk or it was felt that a chest radiograph should be deferred). Sixty (2.1%) responded affirmatively to one or more questions. canadian neighborhood pharmacy

Chest radiographs were performed on 1,376 employees and volunteers. The vast majority of radiographs (99.1%) was normal (Table 2). After further clinical evaluation by the employee clinic’s pulmonary physician, one employee (0.1%) was diagnosed with active TB. The single case of TB occurred in an established employee who was a PPD convertor. The diagnosis of active TB was made at the time of PPD conversion and therefore INH had not previously been offered to this person. This employee had no known exposure to an active TB case and was identified on routine screening. …Read the rest of this article

Effectiveness of a Nosocomial Tuberculosis Control Program at an Urban Teaching Hospital: Results2Number of Cases of TB and Delay in Diagnosis
There were 85 cases of sputum culture-positive TB at UCSD Medical Center between 1993 and 1995. Of these, 69 (81.2%) were AFB smear-positive. Seventy-one patients with TB were diagnosed upon admission. In 14 patients who were not initially placed in isolation, the diagnosis was delayed a mean of 4.6 days and a median of 2 days (SD, 5.4 days; range, 1 to 18 days). Eleven of these 14 (78.6%) had a positive AFB smear from a respiratory specimen (although several had a positive smear from bronchoscopy only).
Demographics of Employee Population
UCSD Medical Center is an urban teaching hospital with 440 beds. For the years 1993, 1994, and 1995, the numbers of new and established employees and volunteers at UCSD Medical Center were 5,784, 5,705, and 5,720, respectively. While the majority of personnel was born in the United States, a significant percentage of employees was foreign-born (20.1%) (Table 1). Of United States-born employees, 26.7% were members of a racial or ethnic minority group. …Read the rest of this article

In general a significant exposure is considered to have occurred if an employee has unprotected face-to-face contact with a patient (regardless of duration or frequency of visits ) who is later determined to have AFB smear-positive pulmonary TB. When the source case of the potential exposure is not sputum AFB smear-positive, the determination of the need for an exposure evaluation is made by the medical centers Tuberculosis Control Officer on a case-by-case basis.
If it is determined that an employee has had a significant exposure, further evaluation is based on his or her prior PPD status. For those with prior PPD less than 10 mm, a new PPD is required immediately. If this new PPD is less than 10 mm, another PPD is required at 10 weeks after exposure. If either of these PPD tests is 10 mm or greater, a chest radiograph is required. Those with prior PPD of 10 mm or greater are screened with a questionnaire inquiring about potential symptoms compatible with TB 10 weeks after the initial exposure. If the employee answers yes to any question, a chest radiograph is required. cialis professional
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Effectiveness of a Nosocomial Tuberculosis Control Program at an Urban Teaching Hospital: TB Screening PolicyAll new employees and volunteers with a PPD of 10 mm or greater are required to have a chest radiograph. This is also true of all established employees unless they are in one of two categories. Those who have completed at least 6 months of isoniazid (INH) therapy or whose significantly reactive PPD has been documented to be present for least 5 years are considered low-risk. They are given a questionnaire which inquires about symptoms compatible with TB. A questionnaire is also given to any personnel (new or established) in lieu of a chest radiograph if there is a contraindication to radiography (eg, pregnancy). If they answer yes to any question, a chest radiograph is required. …Read the rest of this article

Number of Employees and Cases of TB at UCSD
The number, race, ethnicity, and country of origin of new and established employees and volunteers for the years 1993, 1994, and 1995 were determined from payroll and staffing records maintained by the medical center. The medical center patient database was searched for all patients with a positive sputum culture for Mycobacterium tuberculosis for the years 1993 to 1995. It was also determined if the patient was smear-positive or smear-negative at the time of hospitalization. The charts of all active TB cases were reviewed to determine the delay in diagnosis. canadian neightbor pharmacy

TB Screening Policy
UCSD Medical Center has a written policy that stipulates infection control practices regarding TB. The current policy described below has been in effect since November 1, 1992, and was not changed during the period of this report. …Read the rest of this article