xposure to patients with infectious tuberculosis is a well-recognised hazard of health care and although the risks associated with this hazard cannot be completely eliminated, they can be controlled and minimised. Risk reduction strategies rely upon a hierarchy of control measures to prevent the nosocomial transmission of tuberculosis in healthcare settings. In this article, the authors discuss the background to these strategies and review the evidence that underpins clinically effective administrative and engineering controls and personal respiratory protection. The authors conclude with recommendations and guide readers to further sources of reliable information.
Abruzzi WA, Hummel RJ (1953) Tuberculosis: incidence among American medical students, prevention and the use of BCG. New England Journal of Medicine248: 722-9.
2.
Breathnach AS, de Ruiter A., Holdsworth Gmc, Bateman NT, O'Sullivan Dgm, Rees PJ, Snashall D., Milburn HJ, Peters BS, Watson J., Drobniewski FA, French GL (1998) An outbreak of multi-drug-resistant tuberculosis in a London teaching hospital. Journal of Hospital Infection39: 111-7.
3.
Caperwell S., Leaker AR, Leitch G. (1988) Pulmonary tuberculosis in health service staff — Is there still a problem?Tubercle69: 113-8.
4.
Centers for Disease Control and Prevention (CDC). (1990) Epidemiological notes and reports nosocomial transmission of multidrug resistant tuberculosis to healthcare workers and HIV-infected patients in Urban Hospital — Florida. Morbidity and Mortality Weekly Report39: 718-22.
5.
Daniels M., Ridgehalgh F., Springett V.H., Hall IM ( 1948) Tuberculosis in young adults: report of the Prophit tuberculosis survey: 1935 to 1944. H K Lewis: London: 156-7.
6.
Department of Health. (1996). The prevention and control of tuberculosis in the United Kingdom: recommendations for the prevention and control of tuberculosis at a local level. Report from the Interdepartmental Working Group on Tuberculosis. Department of Health: London.
7.
Department of Health. (1998) The prevention and control of tuberculosis in the United Kingdom: guidance on the prevention and control of transmission of 1) HIV-related tuberculosis 2) drug-resistant, including multiple drug-resistant tuberculosis. Report from the Interdepartmental Working Group on Tuberculosis. Department of Health: London.
8.
Department of Health and Health Protection Agency. (2005) Guidance for pandemic influenza — Infection control in hospitals and primary care settings. See: www.dh.gov.uk/assetRoot/04/12/17/54/04121754.pdf (accessed 13 February 2006).
9.
Ehrenkranz NJ, Kicklighter JL (1972) Tuberculosis outbreak in a general hospital: evidence for airborne spread of infection. Annals of Internal Medicine77: 377-82.
10.
Fennelly KP, Nardell EA (1998) The relative efficacy of respirators and room ventilation in preventing occupational tuberculosis. Infection ControlHospital Epidemiology19: 754-9.
11.
Gammaitoni L., Nucci MC (1997) Using a mathematical model to evaluate the efficacy of TB control measures. Emerging Infectious Diseases3: 335-42.
12.
Griffith DE, Hardman JL, Zhang Y., Wallace RJ, Mazurek GH (1995) Tuberculosis outbreak among healthcare workers in a community hospital. American Journal of Respiratory and Critical Care Medicine152: 808-11.
13.
Haley CE, McDonald RC, Rossi L., Jones WD, Haley RW, Luby JP ( 1989) Tuberculosis epidemic among hospital personnel. Infection Control andHospital Epidemiology10: 204-10.
14.
Hannan M., Bell A., Easterbrook P., Nelson M., Gazzard B., Azadian B., Hawkins DA (1996) An outbreak of multi-drug resistant tuberculosis (MDRTB) in a London teaching hospital HIV/genitourinary medicine unit: outbreak investigations, infection control issues and molecular epidemiology. Genitourinary Medicine72: 307-8.
15.
Hannan MM, Azadian BA, Gazzard BG, Hawkins DA, Hoffman PN (2000) Hospital infection control in an era of HIV infection and multi-drug resistant tuberculosis. Journal of HospitalInfection44: 5-11.
16.
Health Protection Agency. (2005a) Annual report on tuberculosis cases reported in England, Wales and Northern Ireland in 2003. See: www.hpa.org.uk (accessed 8 March 2006).
17.
Health Protection Agency. (2005b) The UK mycobacterial surveil lance network report 1994 to 2003: ten years of MycobNet. See: www.hpa.org.uk (accessed 8 March 2006).
18.
Health Protection Agency. (2005c) Information on facemasks and respirators: frequently asked questions (last reviewed 11 January 2005). See: www.hpa.org.uk/infections/topics_az/SARS/maskFAQs.htm (accessed 13 February 2006).
19.
Heimbeck J. (1928) Immunity to tuberculosis. Archives ofInternal Medicine41: 336-42.
20.
Hoffman PN, Weinbren MJ, Stuart SA (2004) A practical lesson in negative-pressure isolation ventilation. Journal of HospitalInfection57: 345-6.
21.
Houk VN, Baker JH, Sorensen K., Kent DC ( 1968) The epidemiology of tuberculosis infection in a closed environment. Archives of Environmental Health16: 26-35.
22.
Jensen PA, Lambert LA, Iademarco MF, Ridzon R. (2005) Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care settings. MMWR54(RR17): 1-141.
23.
Jereb JA, Klevens RM, Privett TD, Smith PJ, Crawford JT, Sharp VL, Davis BJ, Jarvis WR, Dooley SW (1995) Tuberculosis in healthcare workers at a hospital with an outbreak of multi-drug resistant Mycobacterium tuberculosis. Archives of Internal Medicine155: 854-9.
24.
Joint Tuberculosis Committee of the British Thoracic Society. (2000) Control and prevention of tuberculosis in the United Kingdom: Code of Practice 2000. Thorax55: 887-901.
25.
Meredith S., Watson JM, Citron KM, Cockcroft A., Darbyshire JH (1996) Are healthcare workers in England and Wales at increased risk of tuberculosis?British Medical Journal313: 522-5.
26.
Menzies D., Fanning A., Yuan L., FitzGerald JM, and the Canadian Collaborative Group in Nosocomial Transmission of TB. (2000) Hospital ventilation and risk for tuberculous infection in Canadian healthcare workers. Annals of Internal Medicine133: 779-89.
27.
Pavelchak N., Cummings K., Stricof R., Marshall E., Oxtoby M., London M. (2001) Negative-pressure monitoring of tuberculosis isolation rooms within New York State hospitals. Infection Control andHospital Epidemiology22: 518-9.
28.
Pratt RJ, Grange JM, Williams VG (2005) Tuberculosis: a foundation for nursing and healthcare practice. Hodder Arnold: London : chapter 17.
29.
Riley RL, Mills CC, O'Grady F., Sultan LU, Wittstadt F., Shivpuri DN (1962) Infectiousness of air from a tuberculosis ward . American Review of Respiratory Disease85: 511-25.
30.
Sepkowitz KA (1994) Tuberculosis and the healthcare worker: a historical perspective. Annals of Internal Medicine120: 71-9.
31.
Sutton PM, Nicas M., Harrison RJ (2000) Tuberculosis isolation: comparison of written procedures and actual practices in three California hospitals. Infection Control andHospital Epidemiology21: 28-32.
32.
Wiggam SL, Hayward AC (2000) Hospitals in England are failing to follow guidance for tuberculosis infection control — results of a national survey. Journal of HospitalInfection46: 257-62.
33.
World Health Organization. (1993) Tuberculosis programme and the International Union against Tuberculosis and Lung Disease: Control of tuberculosis transmission in healthcare settings . Weekly Epidemiological Record68: 369-76.
34.
World Health Organization. (2005) Global tuberculosis control — surveillance, planning, financing. World Health Organization Report: WHO/HTM/TB/2005.349World Health Organization: Geneva.
35.
Zaza S., Blumberg HM, Beck-Sague C., Haas WH, Woodley CL, Pineda, M.Parrish C.Crawford JT, McGowan JE, Jarvis WR (1995) Nosocomial transmission of Mycobacterium tuberculosis: the role of healthcare workers in outbreak propagation. Journal of Infectious Diseases172: 1542-9.
