Is the tuberculosis screening program of hospital employees still required?

Abstract

The American Thoracic Society and the Centers for Disease Control recommend that each hospital has a tuberculosis screening program. As the incidence of active tuberculosis in the United States has been decreasing during the last 30 yr, the necessity for continuing this screening program may be questioned. This prospective study evaluates whether screening hospital employees is still useful. In the state of Washington from January 1, 1982, through December 31, 1984, tuberculosis was diagnosed in 747 patients, of whom 387 (52%) were hospitalized. One hundred seventy-one of the hospitalized patients (44%) were sputum-smear-positive. Data were collected from each of the 114 hospitals in the state. During the 3-yr period, 50 hospitals admitted no patients known to have M. tuberculosis, 48 admitted 1 or more sputum-smear-positive patients, and 16 others admitted 1 or more smear-negative patients. The number of employees at each hospital ranged from 10 to 6,289 (539 +/- 757, mean +/- SD). Skin testing was performed on 13.7 to 100% (median, 84.2%) of employees. In the 3-yr period, 126,493 skin tests were placed by trained personnel; 501 employees were reported as being converters, but only 129 were found to be true converters. The conversion rates of employees in hospitals to which patients with smear-positive and smear-negative disease were admitted were 1.05 and 1.09 per 1,000, respectively. The conversion rate in hospitals where no patients with M. tuberculosis were admitted was 0.8 per 1,000. These conversion rates were no greater than that predicted for the general population.(ABSTRACT TRUNCATED AT 250 WORDS)