Tuberculosis in hospital workers:A summary of Canadian data

Abstract

Summary o 1. A questionnaire was sent to the directors of all tuberculosis sanatoria and general hospitals with tuberculosis wards in Canada, to determine the means adopted to ascertain the incidence of infection of workers in the hospitals, especially nurses. Three-fourths answered. 2. In all hospitals from which an answer was received, it is the rule either totuberculin test the nurses who are entering service and to X-ray the positive reactors, or to take skiagrams of the chests of all entrants into the nursing service as a routine. 3. The negative reactors are tested usually at three-month intervals as a routine, until they show a positive reaction, at which time they are X-rayed. 4. Skiagrams are taken of all positive reactors at yearly intervals or oftener if thereare indications of a beginning chest lesion. 5. Two-thirds of the hospitals prefer positive reactors, and about one-fourthof them will accept only positive reactors. Some have to accept negative reactors because of the high incidence of negative reactors among their applicants, especially in areas in which the nursing personnel is drawn largely from rural districts. About one-third felt that there should be no discrimination between negative and positive reactors. Figures submitted from the nursing service of the mental hospitals of Ontario, although small, suggest that the negative reactors are at a disadvantage and develop lesions in greater proportions than do the positive reactors. 6. Most of the sanatoria accept graduate nurses only, or in such proportions thatmost of the staff are graduates. In the general hospital with a tuberculosis section, the nurses on the tuberculosis wards are for the most part undergraduates. 7. Many of the answers indicated that raising the age at which nurses were accepted for tuberculosis work to 28 to 30 would be beneficial in lowering the incidence of tuberculosis among nurses. 8. All answers agreed that in Canada there was a much higher incidence oftuberculosis among nurses on a general service than among nurses who were on a tuberculosis service, due to unrecognized cases of the disease infecting the general nurse. 9. Because of the risk of infection incurred by the nurse, and of the risk of lawsuitfor compensation instituted by a nurse infected while in its service, incurred by the hospital, all hospitals should tuberculin test their applicants for entrance into the nursing service as a routine to determine the incidence and extent of infection; followed by routine examinations at three-month intervals for the negative reactors, and skiagrams of the chests for the positive reactors.