compliance. Also, the time distribution of surveys was not noted. Thus, low compliance may also reflect a lag time in planning and implementing a comprehensive program, especially if many surveys were at the early end of the survey period.

Although these initial studies suggested poor initial implementation of the guidelines, with time implementation overall seems to have improved. Part I of the 1993 SHEA-CDC survey reported by Fridkin et al. (23) covered the status of tuberculosis control practices from 1989 to 1992. The results were as follows. Members from 210 (out of 359 possible) hospitals responded to the survey.

Tuberculosis isolation rooms meeting all CDC criteria were available at 113/181 (62 percent) hospitals. A total of 205/205 (100 percent) placed suspected tuberculosis patients in private rooms, 138/181 (76 percent) had negative pressure, 140/181 (77 percent) had air exhaust directly to the outside, and 158/189 (84 percent) reported ≥6 ACH. UVGI was used in 14/196 (7 percent). Employee PPD testing at 199 reporting hospitals was done annually at 127 (64 percent), every 6 months at 10 (5 percent), every 2 years at 13 (7 percent), and at varied times depending on risk at 48 (24 percent). Personal respiratory protection provided varied of the time period, as shown in Table D-7.

The authors note that there was still room for improvement in having appropriate tuberculosis isolation rooms available, but noted that the high cost of construction would likely make this a slow process. They also noted a trend toward the adoption of more compliant personal respiratory protection consistent with the 1990 CDC guidelines.

The results of a survey of U.S. hospitals by the Hospital Infections Program (HIP) of CDC were reported by Manangan and colleagues (51). A sample of US hospitals from the American Hospital Association database was surveyed in 1992. The response rate was 763/1076 (71 percent). In 1996, hospitals that had had ≥6 tuberculosis admissions in 1991 were resurveyed.

The 1992 survey showed that from 1989 to 1991 there was an increase in the proportion of hospitals admitting patients with tuberculosis and in

TABLE D-7. Personal Respiratory Protection Trends from 1993 CDC-SHEA Survey

Percent

Respiratory Protection

1989

1990

1991

1992

Surgical mask

95

94

92

57

Submicron mask

4

5

5

20

Dust-mist respirator

1

1

3

13

Dust-mist-fume respirator

0

0

0

10

HEPA respirator

0

0

0

0



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