Nosocomial tuberculosis: new progress in control and prevention.

Nosocomial cases of tuberculosis have affected both health care workers and hospitalized patients, and each group has transmitted the infection to the other. This situation has been exacerbated by increases in the number of patients concurrently infected with human immunodeficiency virus and organisms resistant to multiple drugs; by inadequate implementation of procedures for the recognition, isolation, and treatment of patients with tuberculosis in health care and correctional facilities; and by a lack of practical engineering interventions for the control of airborne transmission. Epidemics at several hospitals have been controlled by the implementation of multiple measures listed in recent federal guidelines. Rapid recognition of cases and their effective isolation should be a priority at public hospitals, which can least afford the expensive engineering changes and personal respirators that are now mandated. Lacking are data on engineering controls (especially for retrofitting of existing facilities) and requirements for mask use that are both effective and financially practical. If relevant programs are to be developed, new methods are needed for the direct measurement of airborne transmission of tuberculosis. Fortunately, new federal guidelines allow individual hospitals and health care systems the flexibility to assess likely risk and to act in accordance with their findings to develop system-wide control programs.