Study Of Latent Tuberculosis Infection And Prevention Strategy Among Health Care Workers In Two Hospitals

Background: China is a high tuberculosis(TB) burden country. The status of latent tuberculosis infection, knowledge of TB prevention and treatment policy and personal occupational protection among health care workers(HCW) were not well recognized in the past studies in China. The risk of TB nosocomial infection control has not also been concerned in China. Therefore, studies in these aspects should be conducted and explore the strategies for improving TB occupational protection and nosocomial infection control.Objective: 1. To determine the impact factors of latent tuberculosis infection among HCW in two types of public hospitals; 2. To understand the level of knowledge of TB prevention and treatment policy and personal occupational protection among HCW in two types of public hospitals; 3. To determine the impact factors of willingness of accepting tuberculin skin test(TST) among HCW in public infectious disease hospital; 4. To assess the risk of TB infection in two types of hospitals and explore the strategies for improving TB prevention and control in medical institutions in China.Materials and methods: A cross-sectional study was carried out among HCW in two types of public hospitals. After getting written informed consent, each participant completed a structured questionnaire and performed a TST. Factors associated with latent tuberculosis infection and willingness of accepting TST were identified by logistic regression analysis. Knowledge of TB prevention and treatment policy and personnel occupational protection were evaluated and compared between two hospitals. Self-designed risk assessment forms were used to gather the nosocomial infection control information. Current status of TB hospital infection control and occupational protection strategies were described and used for assessing the hospital infection risks in the two hospitals.Results: 1. Eight hundred and thirty six HCW completed questionnaires and 72.5%(n=606) took the TST or had previous positive results. The TST-positive prevalence was 34.2%(n=325) in the general hospital and 62.6%(n=281) in the infectious disease hospital. The department of hospital work(OR=2.26; 95%CI, 1.33, 3.83), had ever worked in HIV clinic or ward(OR=6.39; 95%CI, 1.26, 32.51), not eating breakfast(OR=3.87; 95%CI, 1.40, 10.73) were significantly associated with latent tuberculosis infection in general hospital. Department of hospital work(OR=1.79; 95%CI, 1.06, 3.03), the duration of employment in the healthcare profession(OR=2.72; 95%CI, 1.59, 4.66), the duration of employment in TB clinic or wards(OR=2.36; 95%CI, 1.14, 4.88) were significantly associated with latent tuberculosis infection in infectious disease hospital. The duration of employment in the healthcare profession(6-10 years vs. ≤5 years [OR=1.89; 95% CI=1.10, 3.25] and >10 vs. ≤5 [OR=1.80; 95% CI=1.20, 2.68]), type of hospital(OR=2.40; 95% CI=1.59, 3.62), and ever-employment in a HIV clinic or ward(OR=1.87; 95% CI=1.08, 3.26) were significantly associated with latent tuberculosis infection.2. The awareness rate of TB prevention and treatment knowledge were 77.8% in general hospital and 86.7% in infectious disease hospital. There were significant differences on TB knowledge level among clinical HCW in two hospitals. Occupational protection measures were better used in infectious disease hospital than in general hospital. 3. The acception rate of TST was 76.9% among HCW in infectious disease hospital. The reasons of unwilling to accept TST were past TST positive result, ache and blister in skin, et al. The duration of employment in the health care profession(OR=0.52; 95% CI: 0.34, 0.82) and the duration of employment in TB clinic or wards(OR=0.62; 95% CI: 0.39, 0.97) were significantly associated with the willingness of accept TST in infectious disease hospital. 4. The risk of TB infection in infectious disease hospital was higher than in general hospital. Both of the two hospitals had the same nosocomial infection control administration management. The infectious disease hospital had higher level of administrative controls,environmental engineering controls, TB laboratory test and personal controls. TST screening and serial detection of latent tuberculosis infection had been developed among HCW in infectious disease hospital. But both of the two hospitals lacked of mechanism to recognize the failure of TB nosocomial infection control.Conclusion: HCW who worked in infectious disease hospital or in some departments of general hospital were the high risk population of latent tuberculosis infection. Comprehensive guidelines should be developed to instruct nosocomial infection control in different types of medical institutions. Risk assessment and application of new technique could improve the ability of TB nosocomial infection control and latent tuberculosis infection surveillance among HCW.