Tuberculosis Control Is a Team Sport

Abstract

An especially disturbing characteristic of the recent tuberculosis (TB) epidemic was the transmission of TB in hospitals and other institutional settings. 1 Davis YM McCray E Simone PM Hospital infection control practices for tuberculosis.. Clin Chest Med. 1997; 18: 19-33 Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar Although multiple factors contributed to nosocomial TB transmission, a common critical element was the delayed diagnosis of contagious TB cases. In response to this threat to both health-care workers and patients, the Centers for Disease Control and Prevention (CDC) generated new guidelines mandating more rigorous institutional TB control measures. 2 Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care facilities.. MMWR. 1994; 43 (RR-13): 1-132 Google Scholar Adoption of these measures, as well as the declining incidence of TB in the United States, are associated with decreased nosocomial TB transmission. 3 Maloney SA Pearson ML Gordon MT et al. Efficacy of control measures in preventing nosocomial transmission of multidrug-resistant tuberculosis to patients and health care workers.. Ann Intern Med. 1995; 122: 90-95 Crossref PubMed Scopus (159) Google Scholar , 4 Stroud LA Tokars JI Grieco MH et al. Evaluation of infection control measures in preventing the nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis in a New York City hospital.. Infect Control Hosp Epidemiol. 1995; 16: 141-147 Crossref PubMed Scopus (63) Google Scholar , 5 Centers for Disease ControlTuberculosis morbidity – US 1996.. MMWR. 1997; 46: 695-699 PubMed Google Scholar I believe, however, that the decreased risk to health-care workers is at least equally the result of a massive TB education effort targeting health-care workers. Without the increased TB awareness that results in the rapid identification of contagious TB cases, no institutional control measures would be successful. In this issue of CHEST (see page 681), Divinagracia and colleagues describe an unintended but perhaps predictable financial liability that arose in concert with the success of the education effort. Overly aggressive TB diagnostic efforts can be viewed, in fact, as a hard won victory over the previous lack of TB awareness. If there were no excessive costs associated with the aggressive evaluation of all conceivable TB suspects, then there would be no problem. There is a problem, of course, because aggressive evaluation of TB is expensive, but the results of this study also demonstrate how cooperation between primary care providers and TB specialists can reduce unnecessary expenditure of medical resources without compromising patient care.