Tuberculosis infection control practice in hospitals from the viewpoint of occupational health]

Several outbreaks of tuberculosis (TB) among health care workers were reported recently in Japan. To assess the current situation of TB infection control practice in hospitals in Japan from the viewpoint of occupational health, we carried out a cross sectional survey by mail-questionnaires. The questionnaires with closed and open-ended questions to ask situation of TB infection control program in hospital were mailed to 542 hospital chiefs in and around Tokyo, Kantoh district. 269 replies were received. We analyzed them especially focussing on the prevention of TB among health care workers. Out of 269 hospitals replied, 39 of them had wards and/or beds designated for tuberculosis patients, 223 did not have, and 7 were unknown. 102 (38.9%) had set written tuberculosis infection control programs or guidelines, only 21 (53.8%) have set them even in hospitals with TB beds. 110 (42.0%) hospitals had triage system for identifying patients with active TB in the outpatient setting. Although, most health care workers underwent annual health check programs including chest X-rays, only 67 (25.6%) of the hospitals provide tuberculin skin test to their new recruits. 165 (63.0%) of hospitals admit that undiagnosed patients with respiratory symptoms may stay with immuno-compromised patients in the same room. Since administrative management, staff education, environmental control in work place, personal infection control and individual health care should be carried out from the viewpoint of occupational health, we showed concrete steps of these in this paper. We recommend that a TB infection control manager in each hospital should be designated, and that TB infection control program and/or guideline should be made. Environmental control in work place to prevent infection should be more prioritized in Japan.