BACKGROUND: In industrialised countries, occupational tuberculosis among healthcare workers (HCWs) is re-emerging as an important public health issue. To prevent and control tuberculosis transmission, several institutions have issued and implemented recommendations and practice guidelines. OBJECTIVES: To estimate the annual rate of tuberculosis infection (ARTI; per 100 person-years) among HCWs in Turin, the capital of the Piedmont region of Italy, to identify factors associated with variations in the ARTI and to evaluate the efficacy of the regional guidelines to prevent and control tuberculosis. METHODS: The study was conducted between 1997 and 2004 on a cohort of HCWs. The tuberculosis infection was diagnosed through tuberculin skin testing (TST) conversion and defined as an induration increase of at least 10 mm from a previous negative TST. The ARTI and the hazard ratio for each at-risk subgroup, categorised according to working activities and settings, was estimated using exponential survival models. The efficacy of the regional guidelines was estimated by stratifying the analysis according to the moment of the implementation of the guidelines (before/after). RESULTS: The 2182 study participants were drawn from the dynamic cohort. The overall adjusted ARTI was 1.6 (95% CI: 1.3 to 1.9)/100 person-years. Different workplaces (eg, administrative and infectious diseases inpatient services) and occupations (eg, clerical and medical workers) were associated with significantly different ARTIs, ranging between 0.62 and 2.62 and between 0.61 and 1.71, respectively, whereas the TST conversion risk differed by about 16-68% and 30-60%, respectively. The implementation of the guidelines coincided with overall ARTI reductions of 1.3/100 person-years, and concurrently the variations between ARTIs of different occupations and workplaces disappeared. CONCLUSIONS: The occupational risk categories for targeting the surveillance and prevention of tuberculosis transmission among HCWs were identified, and the introduction of preventive measures was observed to be effective in decreasing the overall risk of tuberculosis infection among HCWs.
BACKGROUND: In industrialised countries, occupational tuberculosis among healthcare workers (HCWs) is re-emerging as an important public health issue. To prevent and control tuberculosis transmission, several institutions have issued and implemented recommendations and practice guidelines. OBJECTIVES: To estimate the annual rate of tuberculosis infection (ARTI; per 100 person-years) among HCWs in Turin, the capital of the Piedmont region of Italy, to identify factors associated with variations in the ARTI and to evaluate the efficacy of the regional guidelines to prevent and control tuberculosis. METHODS: The study was conducted between 1997 and 2004 on a cohort of HCWs. The tuberculosis infection was diagnosed through tuberculin skin testing (TST) conversion and defined as an induration increase of at least 10 mm from a previous negative TST. The ARTI and the hazard ratio for each at-risk subgroup, categorised according to working activities and settings, was estimated using exponential survival models. The efficacy of the regional guidelines was estimated by stratifying the analysis according to the moment of the implementation of the guidelines (before/after). RESULTS: The 2182 study participants were drawn from the dynamic cohort. The overall adjusted ARTI was 1.6 (95% CI: 1.3 to 1.9)/100 person-years. Different workplaces (eg, administrative and infectious diseases inpatient services) and occupations (eg, clerical and medical workers) were associated with significantly different ARTIs, ranging between 0.62 and 2.62 and between 0.61 and 1.71, respectively, whereas the TST conversion risk differed by about 16-68% and 30-60%, respectively. The implementation of the guidelines coincided with overall ARTI reductions of 1.3/100 person-years, and concurrently the variations between ARTIs of different occupations and workplaces disappeared. CONCLUSIONS: The occupational risk categories for targeting the surveillance and prevention of tuberculosis transmission among HCWs were identified, and the introduction of preventive measures was observed to be effective in decreasing the overall risk of tuberculosis infection among HCWs.
Authors: J Alonso-Echanove; R M Granich; A Laszlo; G Chu; N Borja; R Blas; A Olortegui; N J Binkin; W R Jarvis Journal: Clin Infect Dis Date: 2001-07-25 Impact factor: 9.079
Authors: I Baussano; M Bugiani; D Gregori; R van Hest; A Borraccino; R Raso; F Merletti Journal: Int J Tuberc Lung Dis Date: 2006-04 Impact factor: 2.373
Authors: A Matteelli; C Casalini; M C Raviglione; I El-Hamad; C Scolari; E Bombana; M Bugiani; M Caputo; C Scarcella; G Carosi Journal: Am J Respir Crit Care Med Date: 2000-11 Impact factor: 21.405
Authors: Adelisa L Panlilio; Dale R Burwen; Amy B Curtis; Pamela U Srivastava; John Bernardo; Michela T Catalano; Meryl H Mendelson; Peter Nicholas; William Pagano; Carol Sulis; Ida M Onorato; Mary E Chamberland Journal: Clin Infect Dis Date: 2002-07-03 Impact factor: 9.079
Authors: Katrina M Pollock; Herman Tam; Lisa Grass; Sharleen Bowes; Graham S Cooke; Manish Pareek; Damien Montamat-Sicotte; Moses Kapembwa; Graham P Taylor; Ajit Lalvani Journal: BMJ Open Date: 2012-03-01 Impact factor: 2.692
Authors: Monica Lamberti; Mariarosaria Muoio; Antonio Arnese; Sharon Borrelli; Teresa Di Lorenzo; Elpidio Maria Garzillo; Giuseppe Signoriello; Stefania De Pascalis; Nicola Coppola; Albert Nienhaus Journal: J Occup Med Toxicol Date: 2016-11-24 Impact factor: 2.646
Authors: Albert Nienhaus; Anja Schablon; Alexandra M Preisser; Felix C Ringshausen; Roland Diel Journal: J Occup Med Toxicol Date: 2014-03-14 Impact factor: 2.646