Effectiveness of a Nosocomial Tuberculosis Control Program at an Urban Teaching Hospital: TB Screening Policy
All 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.
All chest radiographs are read by a radiologist and then examined by the pulmonary physician in charge of the employee TB control clinic. Any employee with a radiograph possibly compatible with active TB undergoes further evaluation, which includes, at minimum, obtaining sputum samples for acid-fast bacilli (AFB) smear and culture. These employees are not allowed to begin or continue working until they have been cleared by this clinic. sildenafil citrate pink
Isolation Procedures, Determination of Employee Exposure, and Follow- Up of Exposures
When a patient is identified as a TB case or suspect, the patient is placed in an appropriate isolation room (negative pressure, more than 6 air changes/h). Negative pressure for each isolation room is verified on a quarterly basis. The number of air changes is verified at the time the room is set up as an isolation room, but not routinely thereafter. Isolation rooms are not equipped with ultraviolet lighting. A sign is placed on the door (which is kept closed all the time except when the patient, an employee, or a visitor enters or exits) indicating that airborne isolation precautions are in effect. All individuals entering the room are required to wear a protective mask (from 1993 to 1994; Submicron Molded Surgical Mask; 3M; St. Paul, Minn; in 1995; Particulate Filter Respirator 95; Tecnol Inc; Fort Worth, Tex). Fit testing is not done. If it is necessary for the patient to leave the room, he is required to wear a protective mask until he returns. The patient remains in isolation until he has been determined to be nonin-fectious, usually by having three respiratory specimens that are AFB smear-negative on 3 consecutive days, or until discharge.