in airflow) in 44 percent of rooms; no engineering controls in a chest clinic that saw tuberculosis patients; and unmasked tuberculosis patients leaving room to smoke, use a phone, watch television, use a bathroom (the number of tuberculosis isolation rooms without bathrooms was not stated).
Thus, measures that would have been on a typical survey tool would have shown good results. However, the practices were sometimes poor. In addition, parameters that are rarely checked (e.g., airflow patterns and air mixing) may not be optimal according to the guidelines, even if other criteria for a tuberculosis isolation room are met. The actual significance of this is unknown.
Tuberculosis control practices at facilities for children were the focus of an APIC-CDC survey of children’s hospitals and hospitals with pediatric units with >30 beds (56, 57). The survey covered 1990 to 1994. Overall, 195/284 (69 percent) hospitals responded (including 63/83 [76 percent] of freestanding children’s hospitals). Part I of the survey (56) reviewed isolation policies. There was an increase in total tuberculosis cases tuberculosis and resistant tuberculosis reported over the survey period.
Control practices implemented by the hospitals included the following:
175/178 (98 percent) isolated patients with cavitary disease
176/179 (98 percent) isolated patients with AFB+ smears
120/175 (69 percent) isolated patients with miliary tuberculosis
138/175 (79 percent) isolated patients with AFB + gastric aspirates
9/179 (5 percent) allowed patient to leave room for nonmedical reason
96/139 (69 percent) restricted parents/adult visitors to isolation room
57/135 (42 percent) denied visiting privileges of parents until a tuberculosis evaluation done
40 percent of hospitals inappropriately required patients to wear dust-mist-fume (DMF) or HEPA masks when out of room
A total of 14 “clusters” of ≥2 PPD conversions among health care workers were reported from 11/191 (6 percent) hospitals, with one child PPD conversion reported.
Part II of the survey (57) reviewed the physical facilities available for tuberculosis control at the hospitals. Results included the following:
166/194 (86 percent) had facilities to care for a child with tuberculosis
78/190 (41 percent) had a pediatric-specific tuberculosis policy
83/187 (44 percent) stated that 1994 OSHA compliance memorandum caused change in policy
158/171 (92 percent) had isolation room with ≥6 ACH
153/170 (90 percent) vented air directly to outside