Published ahead of print on November 21, 2002, doi:10.1164/rccm.200208-873BC Am. J. Respir. Crit. Care Med., Volume 167, Number 4, February 2003, 599-602 A more recent version of this article appeared on February 15, 2003
Submitted on August 15, 2002 FACTORS ASSOCIATED WITH TUBERCULIN CONVERSION IN CANADIAN MICROBIOLOGY AND PATHOLOGY WORKERSDick Menzies1*,1 Medicine and Epidemiology and Biostatistics, McGill University, Montreal, QC, Canada, 2 Division of Infectious Diseases, Edmonton, Alberta, Canada, 3 Public Health Services, University of Toroton, Toronto, ON, Canada, 4 Medicine, University of British Columbia, BC, Canada * To whom correspondence should be addressed. E-mail: dick.menzies{at}mcgill.ca.
The risk of occupational tuberculosis (TB) infection and associated factors, was estimated among all microbiology and pathology technicians and compared to a sample of non-clinical personnel in 17 Canadian acute care hospitals. Participants underwent tuberculin skin testing and completed questionnaires. Prior skin tests and vaccinations, and all TB patients hospitalized in the preceding three years were reviewed. Of the work areas where direction of air flow and air changes per hour were measured, only 51% were adequately ventilated. Among participating lab workers the average annual risk of tuberculin conversion was 1.0%. This was associated with lower hourly air exchange rates (16.7 vs 32.5 in workers with no conversion, P <.001) work in pathology [adjusted odds ratio: 5.4; (95% confidence interval: 1.3,22), higher proportion of patients with missed diagnosis in the first 24 hours [per 20% increase - OR: 2.0; (1.3,3.2), treatment delayed one week or more [per 20% increase - OR: 2.0; (3.2,3.2)], and higher mortality [per 20% increase - OR: 2.5; (1.1, 5.6)]. We conclude that laboratory workers, with no direct patient contact, have increased risk of tuberculin conversion in hospitals where a greater proportion of TB patients die, or have delayed, or missed diagnosis, although this may be modified by workplace ventilation. Key words: Tuberculosis, nosocomial transmission, occupational tuberculosis infection, autopsy, pathology and microbiology.
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