Risk of tuberculin conversion among healthcare workers and the adoption of preventive measures

Iacopo Baussano, Massimiliano Bugiani, Aurelia Carosso, Dario Mairano, Anna Pia Barocelli, Marina Tagna, Vincenza Cascio, Pavilio Piccioni, Walter Arossa

Risultato della ricerca: Contributo su rivistaArticolo in rivistapeer review

Abstract

Background: In industrialised countries, occupational tuberculosis among healthcare workers (HCWs) is reemerging as an important public health issue. To prevent and control tuberculosis transmission, several institutions have issued and implemented recommendations and practice guidelines. Objectives: To estimate the annual rate of tuberculosis infection (ARTI; per 100 person-years) among HCWs in Turin, the capital of the Piedmont region of Italy, to identify factors associated with variations in the ARTI and to evaluate the efficacy of the regional guidelines to prevent and control tuberculosis. Methods: The study was conducted between 1997 and 2004 on a cohort of HCWs. The tuberculosis infection was diagnosed through tuberculin skin testing (TST) conversion and defined as an induration increase of at least 10 mm from a previous negative TST. The ARTI and the hazard ratio for each at-risk subgroup, categorised according to working activities and settings, was estimated using exponential survival models. The efficacy of the regional guidelines was estimated by stratifying the analysis according to the moment of the implementation of the guidelines (before/after). Results: The 2182 study participants were drawn from the dynamic cohort. The overall adjusted ARTI was 1.6 (95% CI: 1.3 to 1.9)/100 person-years. Different workplaces (eg, administrative and infectious diseases inpatient services) and occupations (eg, clerical and medical workers) were associated with significantly different ARTIs, ranging between 0.62 and 2.62 and between 0.61 and 1.71, respectively, whereas the TST conversion risk differed by about 16-68% and 30-60%, respectively. The implementation of the guidelines coincided with overall ARTI reductions of 1.3/100 person-years, and concurrently the variations between ARTIs of different occupations and workplaces disappeared. Conclusions: The occupational risk categories for targeting the surveillance and prevention of tuberculosis transmission among HCWs were identified, and the introduction of preventive measures was observed to be effective in decreasing the overall risk of tuberculosis infection among HCWs.

Lingua originaleInglese
pagine (da-a)161-166
Numero di pagine6
RivistaOccupational and Environmental Medicine
Volume64
Numero di pubblicazione3
DOI
Stato di pubblicazionePubblicato - mar 2007
Pubblicato esternamente

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