Routinely offered prenatal HIV testing

Tuberculosis among adult visitors of children with suspected tuberculosis and employees at a children's hospital

OBJECTIVE

Few children with tuberculosis (TB) have communicable disease, and most do not require isolation within the hospital. However, parents or adult visitors with unrecognized pulmonary TB may be a threat to hospital staff and other patients. We prospectively evaluated adults accompanying children hospitalized for suspected TB at a children's hospital to determine the frequency of undiagnosed, potentially contagious disease.

METHODS

From 1992 to 1998, chest radiographs were obtained from adult caretakers accompanying 59 consecutive children admitted to Texas Children's Hospital with suspected TB. A child and his or her family were placed under Airborne Precautions only if the child or the accompanying adult exhibited characteristics of potentially contagious disease. Annual rates of tuberculin skin test conversion in hospital employees were obtained for the same period.

RESULTS

Of the 105 screened adults, 16 (15%) had previously undetected pulmonary TB. These adults were associated with 14 (24%) of the 59 children. In all instances in which the adult was the patient's parent, he or she was the source of infection to the child. Only 8 (13.5%) of the 59 children required isolation. Tuberculin skin test conversion from a negative to a positive reaction occurred in 127 employees (8 per 1,000 employee-years at risk). Only 4 of these 127 employees performed activities involving direct patient contact. None was in contact with families with a known potentially contagious adult or pediatric patient.

CONCLUSIONS

The risk of infection of healthcare workers from pediatric patients with primary TB appeared to be minimal, and most children with TB did not need isolation. Infection control efforts should be focused on accompanying adults and adult visitors.

APIC and CDC survey of Mycobacterium tuberculosis isolation and control practices in hospitals caring for children. Part 2: Environmental and administrative controls. Association for Professionals in Infection control and Epidemiology, Inc

BACKGROUND

The 1994 Centers for Disease Control and Prevention draft Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Facilities did not exempt pediatric facilities from instituting controls to prevent nosocomial tuberculosis (TB) transmission. Many researchers contend that TB disease in children does not require such rigid controls. We surveyed acute-care pediatric facilities in the United States to determine adherence to environmental and administrative control recommendations.

METHODS

The study included 4 mailings of a survey to infection control professionals at 284 US children's hospitals and adult acute-care hospitals with > 30 pediatric beds.

RESULTS

Isolation rooms (IRs) generally conformed to recommended guidelines; 92% of respondents reported IRs with > or = 6 air changes per hour, 90% reported 1-pass air and negative pressure, and 89% reported that IRs were private rooms. A sufficient number of inpatient IRs were reported by 88%, but only 42% had IRs in outpatient areas, and 19% had IRs in off-site clinics. Employee tuberculin skin-test programs were in place at 98% of facilities, but policies pertaining to implementation varied. Employees' use of personal respirators increased at respondent hospitals from 1991 to 1994, but as late as 1994, nearly one third still used surgical masks for high-risk procedures.

CONCLUSIONS

Environmental and administrative controls used by respondent hospitals largely conformed to published guidelines. Because definitive studies that quantify the risk of nosocomial M tuberculosis transmission in pediatric settings have yet to be performed, pediatric facilities are required to have the same protections in place as do their adult counterparts.

APIC and CDC survey of Mycobacterium tuberculosis isolation and control practices in hospitals caring for children. Part 1: Patient and family isolation policies and procedures. Association for Professionals in Infection and Epidemiology, Inc

BACKGROUND

The 1994 Centers for Disease Control and Prevention draft Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Facilities did not exempt pediatric facilities from instituting controls to prevent nosocomial tuberculosis (TB) transmission. Many researchers contend that TB disease in children does not require such rigid controls. We surveyed acute-care pediatric facilities in the United States to determine adherence to patient and family isolation policies and procedures.

METHODS

The study included 4 mailings of a survey to infection control professionals at 284 US children's hospitals and adult acute-care hospitals with > 30 pediatric beds.

RESULTS

The overall response rate was 69%. Only 41% of respondents reported having a written TB policy specifically designed for pediatric patients. Whereas 98% of respondents isolated pediatric patients with confirmed pulmonary TB, only 69% reported isolation of patients with miliary TB, and 79% reported isolation of patients with positive gastric aspirates. TB isolation policies for adult visitors were in place at 69% of hospitals, and 50% of hospitals evaluated adults for TB as part of the child's TB treatment plan. A median of 3 contact investigations occurred at each of 47% of respondent hospitals in the preceding 5 years.

CONCLUSIONS

Isolation and infection control policies for children with pulmonary TB largely conformed to published guidelines but varied for children with nonpulmonary TB. Because the greatest risk of nosocomial TB transmission in pediatric facilities comes from adults with TB, a rapid TB screening process for parents and adult contacts accompanying affected children should be instituted at facilities caring for children.

Occupational exposure to aerosolized pentamidine

Occupational exposure to aerosolized pentamidine has raised questions regarding transmission of tuberculosis and the effect of the drug itself. To estimate the exposure of a health care worker, we measured the ambient concentration of aerosolized pentamidine in field conditions in 36 m3 unventilated treatment room. The amount of pentamidine averaged in three different environmental air samples over a four-hour period was 4.5 +/- 3.6 x 10(-5) mg/m3. This amount is very small compared to the doses received by the patients in whom long-term adverse effects are few. The greater risk to health care workers is probably transmission of tuberculosis from undiagnosed cases, especially in populations with an increased incidence of tuberculosis. Tuberculosis control measures such as improved ventilation and masks should also decrease exposure to ambient air pentamidine until toxicity studies determine long-term adverse effects, if any, of aerosolized pentamidine.