A multicenter evaluation of tuberculin skin test positivity and conversion among health care workers in Brazilian hospitals
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Data
2005-12-01
Autores
Roth, V. R.
Garrett, D. O.
Laserson, K. F.
Starling, C. E.
Kritski, Afranio Lineu [UNIFESP]
Medeiros, Eduardo Alexandrino Servolo de [UNIFESP]
Binkin, N.
Jarvis, W. R.
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SETTING: Four general Brazilian hospitals.OBJECTIVE: To assess the occupational risk of Mycobacterium tuberculosis (TB) in participating hospitals.DESIGN: In phase one of this longitudinal study, a cross-sectional survey documented baseline tuberculin skin test (TST) positivity rates. In phase two, TST conversion rates were evaluated in participants with an initial negative two-step TST. TST conversion data were analyzed to determine risk factors for TB infection using an increase of >= 10 mm compared to baseline TST.RESULTS: The initial TST positivity rate was 63.1%; the follow-up TST conversion rate was 10.7 per 1000 person-months (p-m). Hospital of employment, recent bacille Calmette-Guerin (BCG) vaccination, nosocomial TB exposure, and employment as a nurse were independent risk factors for TST conversion. Hospitals without TB infection control measures had higher conversion rates than those with control measures (16.0 vs. 7.8/1000 p-m, P < 0.001).CONCLUSIONS: This study indicates an important occupational risk of infection in health care settings with a high TB incidence. Longitudinal TST studies are a valuable tool to assess the occupational risk of TB, even in BCG-vaccinated populations, and should be used to direct limited resources for infection control.
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International Journal Of Tuberculosis And Lung Disease. Paris: Int Union Against Tuberculosis Lung Disease (i U A T L D), v. 9, n. 12, p. 1335-1342, 2005.