Objective: To compare trends in nosocomial tuberculosis
(TB) prevention measures and health-care worker (HCW) tuberculin skin
test (TST) conversion of hospitals with HIV-related Pneumocystis
carinii pneumonia (PCP) patients and other US hospitals from
1992 through 1996.
Design and setting: Surveys in 1992
and 1996 of 38 hospitals with PCP patients in four high-HIV-incidence
cities and 136 other US hospitals from the American Hospital
Association membership list.
Twenty-seven hospitals with PCP patients and 103 other US
Results: In 1992, 63% of PCP hospitals and
other US hospitals had rooms meeting Centers for Disease Control and
Prevention (CDC) criteria (ie, negative air pressure,
six or more air exchanges per hour, and air directly vented to the
outside) for acid-fast bacilli isolation; in 1996, almost 100% had
such isolation rooms. Similarly, in 1992, nonfitted surgical masks were
used by HCWs at 60% of PCP hospitals and 68% at other US hospitals,
while N95 respirators were used at 90% of PCP hospitals and 83% of
other US hospitals in 1996. There was a significant decreasing trend in
TST conversion rates among HCWs at both PCP and other US hospitals;
however, this trend varied among all hospitals. HCWs at PCP hospitals
had a higher risk of TST conversion than those at other US hospitals
(relative risk, 1.71; p < 0.0001).
Conclusion: From 1992 through 1996, PCP and other US
hospitals have made similar improvements in their nosocomial TB
prevention measures and decreased their HCW TST conversion rate. These
data show that most hospitals are compliant with CDC TB guidelines even
before the enactment of an Occupational Safety and Health
Administration TB standard.