and costs of follow-up of those with positive PPD test results. The absolute costs of an employee PPD program ranged from $330 to $58,380 per year. The cost per health care worker tested ranged from $3.53 to $12.94. Additional personnel costs for administering a tuberculosis control program ranged from $10,000 (0.25 full-time equivalents [FTE]) to $137,400 (2 FTE). Capital costs for environmental controls ranged from $54,000 to $554,900. Maintenance costs (including increased utility costs due to increased ventilation) were estimated at $4,000 to $25,000 per year.

Kellerman and colleagues (66) also evaluated the costs of tuberculosis control in children’s hospitals in 1994–1995. The Baby and Children’s Hospital-New York Presbyterian Medical Center (BCH-NYPMC) Children’s Hospital and Health Center-San Diego (CHHC-SD), and the pediatric ward at the University of California at San Diego (UCSD) were surveyed. Costs per health care worker for PPD testing ranged from $6.91 to $12.49, with total costs of the program running $2,470 to $26,577 per year. Construction costs for that year ranged from $12,800 to $24,500. Total respirator costs for a year were $1,360 at BCH-NYPMC (with fit testing by manufacturer), $1,680 at CHHC-SD (fit testing was available but was not used), and $480 at UCSD (no fit testing).

While the “data” aspects of the implementation of control measures at Roosevelt in New York City were reviewed by Stroud et al. (18), Williams et al. (67) provided a discussion of the “soft” aspects of the control program. A primary barrier early on was a lack of tuberculosis knowledge by health care workers, which required providing significant education efforts. Because much of the tuberculosis at Roosevelt came through the ED, the medical director there played a key role in educating that department. This led to more timely isolation in the ED.

They noted that a key priority was enlisting the collaboration of the admitting department so that patients could be moved out of the ED in a timely fashion. They developed a system of bed triage based on estimated risk so that tuberculosis isolation rooms would be used appropriately in times of shortage.

Getting health care workers to implement controls was hampered by the perception that prevention of tuberculosis outbreaks was solely the responsibility of infection control, which had “failed” since an outbreak had occurred. Also, the increased numbers of patients on isolation increased the perception that more tuberculosis patients were being admitted, increasing employee fear and anger. However, the concerns of health care workers did spark increased compliance with routine PPD testing.

The authors noted that one key difficulty was keeping patients in their rooms. They tried offering incentives (e.g., free television, free incoming phone calls, special food choices) as suggested in the CDC guidelines, but noted that the actual impact was small. Although this paper does not address any dollar costs in implementing control measures, it



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