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CDC updates guidelines on prevention of tuberculosis in health care settings.

The Centers for Disease Control and Prevention closed out 2005 by updating its 1994 guidelines for preventing Mycobacterium tuberculosis in health care settings.

The exhaustive guidelines were updated in an effort to respond to "shifts in the epidemiology of TB, advances in scientific understanding, and changes in health care practice that have occurred in the United States during the previous decade," wrote the authors, led by Paul A. Jensen, Ph.D., of the division of tuberculosis elimination at the CDC's National Center for HIV, STD, and TB Prevention (MMWR 2005;54[RR-17]:1-121).

The authors noted that although TB rates have declined in recent years, the U.S. incidence rate remains higher than the national goal. "Despite the progress in the United States, the 2004 rate of 4.9 per 100,000 remained higher than the 2000 goal of 3.5. This goal was established as part of the national strategic plan for TB elimination; the final goal is less than 1 case per 1,000,000 population by 2010," they wrote.

Also, health care workers (HCWs) in different areas of the country face different risks. For example, in 2004 the risk of TB per 100,000 population was 1.0 in Wyoming, 7.1 in New York, 8.3 in California, and 14.6 in the District of Columbia.

One key change that makes these guidelines different is the use of the term "tuberculin skin tests" (TSTs) instead of purified protein derivative.

Also, the updated guidelines state that the QuantiFERON-TB Gold test can be used instead of tuberculin skin tests in TB screening programs for health care workers. This one-step blood assay for M. tuberculosis (BAMT) has been approved by the Food and Dug Administration.

The revised guidelines also include these changes:

* Expansion of settings. The guidelines have site-specific recommendations for more types of inpatient and outpatient settings, including surgical suites, laboratories, bronchoscopy suites, autopsy suites, dialysis units, and dental care settings.

* More concise criteria for who needs serial testing for TB infection. Recommendations vary depending on the type of health care setting. In some settings, the frequency of TB screening for HCWs has been decreased. Screening guidelines are also included for workers who transfer to other health care settings.

* New airborne terms. The term "airborne isolation" replaces "respiratory isolation," while the term "airborne infection isolation room" (All room) is defined as "a special negative-pressure room for the specific purpose of isolating persons who might have suspected or confirmed infectious TB disease from other parts of the [health care] setting."

* Instructions on proper respirator use. This includes criteria for selecting respirators and recommendations for annual training and fit testing.

* A nine-page "frequently asked questions" section. One of the questions posed in this section is: "Do health care settings or areas in the United States exist for which baseline two-step skin TST for newly hired HCWs is not needed?"

The reply reads: "Ideally, all newly hired HCWs who might share air space with patients should receive baseline two-step TST (or one-step BAMT) before starting duties. In certain settings, a choice might be offered not to perform baseline TST on HCWs who will never be in contact with or share air space with patients who have TB disease, or will never be in contact with clinical specimens (e.g., telephone operators in a separate building from patients)."

BY DOUG BRUNK

San Diego Bureau
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Title Annotation:News; The Centers for Disease Control and Prevention
Author:Brunk, Doug
Publication:Internal Medicine News
Geographic Code:1USA
Date:Feb 1, 2006
Words:562
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