TABLE D-11. Tuberculosis Isolation Practices in New York City Hospitals, 1992–1994

 

Percent

Measure

1992

1993

1994

p

Tuberculosis patients in shared rooms

12.8

10.5

0

 

No private toilet in room

19.7

6.7

5.3

 

Room with negative pressure

51.3

70.5

80.3

<0.001

Room with HEPA filtration

1.7

20.0

27.6

 

Room with no negative pressure/HEPA/UVGI

32.5

14.3

6.6

 

Room door left open

5.1

3.8

5.3

 

Window in room open

19.7

12.4

9.2

 

Tuberculosis patient isolated on admission

75

 

84

0.02

Patient not isolated until + AFB reported

15

10

7

0.009

Dust-mist respirator

28

 

76

<0.001

AFB done 7 days/week

40

 

95

 

Tuberculosis case reported to health department

80

 

100

 

The discussion notes that improvements in case follow-up led to a decreased length of stay, so that fewer patients were in the hospital at any given time. Overall, there was significant improvement in compliance with CDC guidelines, although glitches (e.g., open doors and windows) persisted.

Unfortunately, as noted previously, survey results may give an incomplete picture. Sutton and colleagues (55) reported the results of a questionnaire and direct observation at three California hospitals (two county, one private-community) in an area where tuberculosis is highly endemic. This was done over 1 year (1994–1995, [exact dates not given]).

All of the hospitals had written tuberculosis plans consistent with CDC guidelines, but none of the hospitals performed routine assessment of their tuberculosis control practices. There were 13–17 tuberculosis isolation rooms available, including at least 1 each in the ICU and ED, at each hospital. Negative pressure was documented in 18/25 (72 percent) tested rooms, and 19/22 (86 percent) tested rooms had ≥6 ACH (6/16 [38 percent] had ≥12 ACH, even though they were not new rooms). However, only 1/27 (4 percent) rooms tested met recommended airflow pattern, and 20/24 (83 percent) had poor-fair air mixing (<10 seconds for puff of smoke to disperse, equivalent to ≥2 breaths for health care workers). The latter measurements are rarely reported in other studies.

One hospital provided HEPA masks with a fit testing program, one used dust-mist (DM) masks without a fit testing program, and one used DM masks but had HEPA masks with fit testing available (but the paper notes that in practice these were not used).

Practices noted on direct observations included lack of regular checks of negative pressure; windows that could be opened (with potential changes



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