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Tuberculin Skin Testing Among Healthcare Workers in the University of Malaya Medical Centre, Kuala Lumpur, Malaysia

Published online by Cambridge University Press:  02 January 2015

Lian-HuatTan ,
Adeeba Kamarulzaman ,
Chong-Kin Iiam  and
Toong-Chow Lee
Lian-HuatTan*
Affiliation:
Infectious Diseases Division, Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
Adeeba Kamarulzaman
Affiliation:
Infectious Diseases Division, Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
Chong-Kin Iiam
Affiliation:
Respiratory Diseases Division, Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
Toong-Chow Lee
Affiliation:
Clinical Investigation Centre, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
*
Department of Medicine, University of Malaya Medical Centre, 59100, Kuala Lumpur, Malaysia
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Abstract

Objectives:

To determine the occupational risk of Mycobacterium tuberculosis infection among healthcare workers (HCWs) and to examine the utility of tuberculin skin testing in a developing country with a high prevalence of bacille Calmette-Guerin vaccination.

Design:

Tuberculin skin test (TST) survey.

Setting:

A tertiary-care referral center and a teaching hospital in Kuala Lumpur, Malaysia.

Participants:

HCWs from medical, surgical, and orthopedic wards.

Intervention:

Tuberculin purified protein derivative RT-23 (State Serum Institute, Copenhagen, Denmark) was used for the TST (Mantoux method).

Results:

One hundred thirty-seven (52.1%) and 69 (26.2%) of the HCWs tested had indurations of 10 mm or greater and 15 mm or greater, respectively. Medical ward HCWs were at significantly higher risk of a positive TST reaction than were surgical or orthopedic ward HCWs (odds ratio, 2.18; 95% confidence interval, 1.33 to 3.57; P = .002 for TST positivity at 10 mm or greater) (odds ratio, 2.61; 95% confidence interval, 1.44 to 4.70; P = .002 for TST positivity at 15 mm or greater). A previous TST was a significant risk factor for a positive TST reaction at either 10 mm or greater or 15 mm or greater, but a duration of employment of more than 1 year and being a nurse were only significantly associated with a positive TST reaction at a cut-off point of 15 mm or greater.

Conclusions:

HCWs at the University of Malaya Medical Centre had an increased risk for M. tuberculosis infection that was significantly associated with the level of occupational tuberculosis exposure. A TST cut-off point of 15 mm or greater may correlate better with M. tuberculosis infection than a cut-off point of 10 mm or greater in settings with a high prevalence of bacille Calmette-Guerin vaccination (Infect Control Hosp Epidemiol 2002;23:584-590).

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 10 , October 2002 , pp. 584 - 590
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

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References

1.Sepkowitz, KA. Tuberculosis and the health care worker: a historical perspective. Ann Intern Med 1994;120:71–79.Google Scholar
2.Beck-Sague, C, Dooley, SW, Hutton, MD, et alHospital outbreak of multidrug-resistant Mycobacterium tuberculosis infection: factors in transmission to staff and HIV-infected patients. JAMA 1992;268:1280–1286.CrossRefGoogle ScholarPubMed
3.Menzies, D, Fanning, A, Yuan, L, Fitzgerald, M. Tuberculosis among health care workers. N Engl J Med 1995;332:92–98.Google Scholar
4.Edlin, BR, Tokars, JI, Grieco, MH, et alAn outbreak of multiresistant tuberculosis among hospitalized patients with acquired immunodeficiency syndrome. N Engl J Med 1992;326:1514–1521.CrossRefGoogle Scholar
5.Dooley, SW, Villarino, ME, Lawrence, M, et alNosocomial transmission of tuberculosis in a hospital unit for HIV-infected patients. JAMA 1992;267:1632–1635.CrossRefGoogle Scholar
6.Pearson, ML, Jereb, JA, Frieden, TR, et alNosocomial transmission of multidrug-resistant Mycobacterium tuberculosis: a risk to patients and health care workers. Ann Intern Med 1992;117:191–196.CrossRefGoogle ScholarPubMed
7.Jarvis, WR. Nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis. Am J Infect Control 1995;23:146–151.CrossRefGoogle ScholarPubMed
8.Jereb, JA, Hevens, RM, Privett, TD, et alTuberculosis in health care workers at a hospital with an outbreak of multi-drug resistant Mycobacterium tuberculosis. Arch Intern Med 1995;155:854–859.CrossRefGoogle Scholar
9.Barnes, PF, Bloch, AB, Davidson, FT, Snider, DE Jr. Tuberculosis in patients with human immunodeficiency virus infection. N Engl J Med 1991;324:1644–1650.Google Scholar
10.Harries, AD. Tuberculosis and human immunodeficiency virus infection in developing countries. Lancet 1990;335:387–390.CrossRefGoogle ScholarPubMed
11.Ritacco, V, Di Lonardo, M, Reniero, A, et alNosocomial spread of human immunodeficiency virus-related multidrug-resistant tuberculosis in Buenos Aires. J Infect Dis 1997;176:637–642.Google Scholar
12.Muzzy de Souza, GR, Cravo, R, Figueira, MM, et alTuberculin conversion among health care workers in a general hospital of Rio de Janeiro, Brazil: final results. Am J Respir Crit Care Med 1998;157:705.Google Scholar
13.Sidibe, K, Zuber, P, Wiktor, SZ, et alTuberculin skin test reactivity among health care workers and level of exposure to tuberculosis patients in Abidjan, Cote d'voire. Int J Tuberc Lung Dis 1997;1(suppl):S103.Google Scholar
14.Wilkinson, D, Crump, J, Pillay, M, Sturm, AW. Nosocomial transmission of tuberculosis in Africa documented by restriction fragment length polymorphism. Trans R Soc Trop Med Hyg 1997;91:318.Google Scholar
15.World Health Organization. Guideline for the Prevention of Tuberculosis in Health Care Facilities in Resource-Limited Settings. Geneva: World Health Organization; 1999.Google Scholar
16.World Health Organization. Global TB Control: WHO Report 2000. Geneva: World Health Organization; 2000.Google Scholar
17.Sepkowitz, KA. Tuberculosis in the 21st century. Emerg Infect Dis 2001;7:259–262.CrossRefGoogle Scholar
18.Centers for Disease Control and Prevention. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health care facilities. MMWR 1994;43(RR-13):1–132.Google Scholar
19.American Thoracic Society, Centers for Disease Control and Prevention. Diagnostic standards and classification of tuberculosis in adults and children. Am J Respir Crit Care Med 2000;161:1376–1395.Google Scholar
20.Centers for Disease Control and Prevention. Targeted tuberculin testing and treatment of latent tuberculosis infection. Am J Respir Crit Care Med 2000;161:S221–S247.CrossRefGoogle Scholar
21.Do, AN, Limpakarnjarat, W, Uthaivoravit, PLF, et alIncreased risk of Mycobacterium tuberculosis infection related to the occupational exposures of health care workers in Chiang Rai, Thailand. Int J Tuberc Lung Dis 1999;3:377–381.Google Scholar
22.Molina-Gamboa, JD, Ponce-de-Leon-Rosales, S, Rivera-Morales, I, et alEvaluation of the sensitivity of RT-23 purified protein derivative for determining tuberculin reactivity in a group of health care workers. Clin Infect Dis 1994;19:784–786.CrossRefGoogle Scholar
23.Molina-Gamboa, J, Fivera-Morales, I, Ponce-de-Leon-Rosales, S. Prevalence of tuberculin reactivity among healthcare workers from a Mexican hospital. Infect Control Hosp Epidemiol 1994;15:319–320.CrossRefGoogle ScholarPubMed
24.Rangel-Frausto, MS, Ponce-de-Leon-Rosales, S, Martinez-Abaroa, C, Haslov, K. Tuberculosis and tuberculin quality: best intentions, misleading results. Infect Control Hosp Epidemiol 2001;22:481–484.CrossRefGoogle ScholarPubMed
25.Huebner, RE, Schein, MF, Bass, JB Jr. The tuberculin skin test. Clin Infect Dis 1993;17:968–975.Google Scholar
26.World Health Organization. Tuberculin. Bull World Health Organ 1958; 19:759–952.Google Scholar
27.Snider, DE Jr. Bacille Calmette-Guerin vaccinations and tuberculin skin tests. JAMA 1985;253:3438–3439.Google Scholar
28.Sepulveda, RL, Ferrer, X, Latrach, C, Sorensen, RU. The influence of Calmette-Guerin bacillus immunization on the booster effect of tuberculin testing in healthy young adults. American Review of Respiratory Disease 1990;142:24–28.Google Scholar
29.Menzies, R, Vissandjee, B. Effect of bacille Calmette-Guerin vaccination on tuberculin reactivity. American Review of Respiratory Disease 1992;145:621–625.Google Scholar
30.Haslov, K, Ponce-de-Leon-Rosales, S, Rangel-Frausto, S, Olesen Larsen, S. Tuberculin PPD RT-23: still going strong. Int J Tuberc Lung Dis. 1998; 2:793–795.Google Scholar
31.Teixeira, L, Maciel, E, Dutra, ME, Perkins, MD, Johnson, JL, do Valle Dettoni, V. Simultaneous comparison of reactivity to purified protein derivative RT-23 and Tubersol in health care workers in Vitoria, Brazil. Int J Tuberc Lung Dis 2000;4:1074–1077.Google Scholar
32.Kim, SJ, Hong, YP, Bai, GH, et alTuberculin PPD RT-23: has it lost some of its potency? Int J Tuberc Lung Dis 1998;2:857–860.Google Scholar
33.Maw, KL, Fujiwara, PI, Munsiff, SS. Prevalence of tuberculin skin test (TST) positivity and conversion rates among New York City Department of Health employees, 1994-1996. Int J Tuberc Lung Dis 1997;1(suppl): S103.Google Scholar
34.Stuart, RL, Bennett, N, Hart, W, et alMantoux testing of health care workers: the Melbourne Mantoux Test Study. Aust N Z J Med 1998;25:712.Google Scholar