Tuberculosis Isolation Comparison of Written Procedures and Actual Practices in Three California Hospitals

Infection Control and Hospital Epidemiology - Tập 21 Số 1 - Trang 28-32 - 2000
Patrice Sutton1, Mark Nicas, Robert J. Harrison
1Public Health Institute, School of Public Health, University of California, Berkeley, USA.

Tóm tắt

AbstractObjective:To evaluate implementation of healthcare worker exposure control measures for tuberculosis (TB)-patient isolation, as specified by Centers for Disease Control and Prevention (CDC) guidelines and the hospital's TB-control policy.Design:Prospective multihospital study comparing CDC guidelines and hospital policy for TB-patient isolation to once-weekly observations of TB-patient isolation practices over 14 consecutive weeks at each hospital.Setting:Three urban hospitals (two county, one private community) in counties in California with a high incidence rate of TB.Measurements:Work practices for TB-patient isolation were observed and ventilation performance of isolation rooms was assessed while patient rooms were in use for TB isolation.Results:Of 170 TB-patient rooms observed, 119 (70%) involved a patient in a designated TB isolation room, the room was under negative pressure, the door was closed, and a “respiratory precautions” sign was on the door; 32 patient-room units (19%) were not under negative pressure or not designated as negative-pressure rooms. Of 151 patient-room units mechanically capable of negative pressure at a prior point in time, 16 (11%) were not under negative pressure at the time of use. Of 67 patient-room units equipped with continuous monitoring devices, 8 (12%) involved devices that did not accurately reflect the direction of airflow. Of the 62 healthcare workers observed using a respirator for TB, 40 (65%) did not don the respirator properly.Conclusions:Implementing CDC guidelines for TB-patient isolation was feasible but imperfect in the three hospitals. Day-to-day work practices deviated from hospital policy. Prospectively quantifying the implementation of a hospital TB isolation policy while the room is in use may lead to improved estimates of risk and may help to identify and thereby prevent avoidable healthcare worker exposures toMycobacterium tuberculosisaerosol. Auditing practices and verifying equipment performance is likely to identify unexpected problems in implementation of the TB control program.

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Tài liệu tham khảo

10.1080/15428119691015179

Stricof, 1994, Mask/particulate respirator use by employees at risk for exposure to multidrug-resistant tuberculosis, Am JRespir Crit Care Med, 149, A855

Sutton, 1999, Handbook of Modern Hospital Safety, 246

10.1001/jama.1992.03490100078031

Watson, 1994, Educating workers about tuberculosis, Occupational Medicine: State of the Art Reviews, 9, 681

Barnhardt, 1997, Tuberculosis in healthcare settings and the estimated benefits of engineering controls and respiratory protection, JOEM, 39, 849

10.7326/0003-4819-120-1-199401010-00012

10.1002/(SICI)1097-0274(199711)32:5<528::AID-AJIM14>3.0.CO;2-4

10.1097/00043764-199403000-00009

10.2307/30141178

10.7326/0003-4819-122-9-199505010-00003

10.2105/AJPH.87.9.1413

10.1016/S0196-0644(98)70349-X

Luby, 1994, A nosocomial outbreak of Mycobacterium tuberculosis, J Fam Pract, 39, 21

1997, Proposed rule and notice of public hearing, Fed Regist, 62, 54160

10.1016/S0196-6553(97)90009-2

10.7326/0003-4819-117-3-191

10.1093/clinids/21.5.1098

1994, Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care facilities, MMWR, 43, 8

10.1001/archinte.1995.00430080100012

La Rochelle, 1995, Protecting the provider from tuberculosis exposure, Nurs Clin North Am, 30, 13, 10.1016/S0029-6465(22)02275-7

10.2307/30141393

10.1086/647670

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Infection Control and Hospital Epidemiology

Tập 21 Số 1

28-32

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