chapter  23
36 Pages

Tuberculosis Infection Control

Tuberculosis (TB) has been recognized by the medical community as a potential occupational hazard for several decades. The risk for transmission of Mycobacterium tuberculosis from hospitalized patients to other patients and health-care workers was established by the 1950s (1) when, as noted by Myers et aI., "rapid decline of tuberculosis in the general population [made] the disease among physicians more conspicuous" (2). While' concern about the threat of tuberculosis to health-care workers is longstanding, during the first half of the twentieth century there was a vigorous debate over whether such a risk existed (3). Heimbeck (4) was one of the first investigators to document the increased risk of occupational infection and development of tuberculosis disease among health-care workers. In 1928 he reported that 210 (95%) of 220 student nurses in Oslo with a negative tuberculin skin test converted their skin test by graduation, and 22% developed clinical tuberculosis. Subsequent reports from large hospitals in the United States (in Philadelphia, Boston, and New York) in the 1930s and early 1940s demonstrated that most nurses working in these institutions converted their tuberculin skin test and were in addition at increased risk of developing tuberculosis disease compared to non-health-care workers (1,5-7).