sure to tuberculosis. Although the 1994 guidelines do include employee tuberculin skin testing programs and personal respiratory equipment, this paper will not address these particular aspects because the topics will be covered in other background papers. One important exception is that employee PPD test conversion rates will be discussed as a marker for the effectiveness of different tuberculosis control plans.

Although the 1994 CDC guidelines are the most current, as summarized above, these guidelines are an extension and revision of the 1990 guidelines. Thus, this paper will review the impact of implementation of policies following both sets of guidelines. As with the guidelines, this paper will focus primarily on the inpatient, acute-care setting. This is partly out of necessity, as there is a paucity of data on implementation of the guidelines in other settings.

Methods

To find papers for review, a MedLine search using Ovid (Ovid Technologies, New York, New York) was performed. The database was searched from the most recent update available in mid-June 2000 back through 1991. Initial search terms were Tuberculosis/pc,ep,tm (Prevention & Control, Epidemiology, Transmission) AND Health facilities. The search was further limited to English-language articles. This yielded 257 references. Abstracts of these references were reviewed to choose appropriate articles. Additional Medline search strategies included Guidelines AND Tuberculosis/pc (which added 5 references not previously obtained), and (Tuberculosis OR Mycobacterium tuberculosis) AND Occupational exposure (which yielded 64 additional references, only 2 of which were useful). The author’s files served as another source of articles. Finally, potentially useful references found while reading the initial papers were also reviewed. Although the guidelines are generally applicable, because the expectation of implementation is primarily in U.S. hospitals, papers regarding health-care facilities outside of the United States were not included. Not all papers reviewed were included in the final document—papers were chosen either for the strength of their data or because they contributed a unique view into the implementation of the CDC standards.

IMPACT OF FOLLOWING THE GUIDELINES

Studies of Implementation of Entire Guidelines

Studies Showing Resolution of Outbreaks

The strongest evidence for the beneficial impact of the CDC guidelines comes from institutions where control measures were implemented



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