occupational tuberculosis. In addition, as noted in Chapter 4, some state regulatory agencies and some accrediting organizations included tuberculosis control measures in their regulations or standards for health care and correctional facilities.
The committee identified three general types of information on the implementation and effects of CDC guidelines: multi-institution surveys, multi-institution inspections, and reports on individual organizations. A few studies focus on the adherence of individuals (e.g., physicians and nurses) to recommended practices such as using personal respiratory protection devices. The literature review in Appendix D includes additional details, and Appendixes B and F also provide relevant information on two specific control measures: tuberculin skin testing and personal respiratory protections. The primary outcome measures reported are tuberculin skin test conversions and cases of active tuberculosis (including multidrugresistant disease).
Again, nearly all the information that the committee located relates to hospitals. The committee found little on nursing homes, ambulatory care clinics, health units of correctional facilities, and other organizations covered by the 1994 CDC guidelines for health care facilities or by the 1996 CDC guidelines for correctional facilities.1
Broadly, implementation refers to the practical activities and interventions undertaken to turn guidelines or policies into desired results. Implementation of the tuberculosis controls measures recommended by CDC calls for a complex set of actions at both the organizational and the individual levels.
The primary focus of the tuberculosis control measures is the organization as a whole rather than the individual. As described in Chapter 4, institutional responsibilities include the preparation and implementation of an overall tuberculosis control plan and record-keeping system; assessment of the tuberculosis risk in the facility; the development and application of written policies and protocols for the rapid identification, isolation, and treatment of individuals with infectious tuberculosis; the creation and maintenance of surveillance, education, and other programs for workers; the establishment and maintenance of appropriate engineering controls for negative-pressure isolation rooms and other areas; and the creation and monitoring of a respiratory protection program.
The CDC recommendations for preventing tuberculosis in correctional facilities describe core activities of screening, containment, and assessment but are generally similar to the guidelines for health care facilities, taking into account differences in the purposes and operation of correctional facilities and health care facilities.