Abstract
BackgroundHospitals with inadequate infection control are risky environments for the emergence and transmission of tuberculosis (TB). We evaluated TB infection control practices, and the prevalence of latent TB infection (LTBI) and TB disease and risk factors in health care workers (HCW) in TB centers in Henan province in China.MethodsA cross-sectional survey was conducted in 2005. To assess TB infection control practices in TB centers, checklists were used. HCW were tuberculin skin tested (TST) to measure LTBI prevalence, and were asked for sputum smears and chest X-rays to detect TB disease, and questionnaires to assess risk factors. Differences between groups for categorical variables were analyzed by binary logistic regression. The clustered design of the study was taken into account by using a multilevel logistic model.ResultsThe assessment of infection control practices showed that only in a minority of the centers the patient consultation areas and X-ray areas were separated from the waiting areas and administrative areas. Mechanical ventilation was not available in any of the TB centers. N95 respirators were not available for HCW and surgical masks were not available for TB patients and suspects. The LTBI prevalence of HCW with and without BCG scar was 55.6% (432/777) and 49.0% (674/1376), respectively (P = 0.003). Older HCW, HCW with longer duration of employment, and HCW who worked in departments with increased contact with TB patients had a higher prevalence of LTBI. HCW who work in TB centers at the prefecture level, or with an inpatient ward also had a higher prevalence of LTBI. Twenty cases of pulmonary TB were detected among 3746 HCW. The TB prevalence was 6.7/1000 among medical staff and 2.5/1000 among administrative/logistic staff.ConclusionTB infection control in TB centers in Henan, China, appears to be inadequate and the prevalence of LTBI and TB disease among HCW was high. TB infection control practices in TB centers should be strengthened in China, including administrative measures, renovation of buildings, and use of respirators and masks. Regular screening of HCW for TB disease and LTBI needs to be considered, offering preventive therapy to those with TST conversions.
Highlights
Hospitals with inadequate infection control are risky environments for the emergence and transmission of tuberculosis (TB)
The patient consultation areas and X-ray areas were in different rooms than the waiting areas and administrative areas in a minority of the TB centers (Table 1)
TB center staff reported that windows were often opened in 43%-67% of patient consultation rooms, sputum examination rooms and Xray rooms. 116 (91.3%) consultation rooms, 121 (95.3%) sputum examination rooms and 73 (57.5%) X-ray rooms had ultraviolet (UV) lights that were situated at upper room
Summary
Hospitals with inadequate infection control are risky environments for the emergence and transmission of tuberculosis (TB). We evaluated TB infection control practices, and the prevalence of latent TB infection (LTBI) and TB disease and risk factors in health care workers (HCW) in TB centers in Henan province in China. Based on a recent national anti-tuberculosis drug resistance survey, it was estimated that approximately 120,000 new multi-drug resistant (MDR) TB cases emerge annually in China, including 9,000 extensively drug-resistant TB (XDR-TB) cases, accounting for approximately 24% of the global burden of MDR-TB [4]. Hospitals with inadequate infection control are risky environments for the emergence and transmission of respiratory infectious diseases, such as TB [5,6]. HCW surveillance, combined with administrative measures and appropriate exposure-based use of personal protective materials and environmental equipment, has helped reduce transmission of TB in some hospitals [9]
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