ABSTRACT
Las tasas de conversiones tuberculínicas (TCT) permiten detectar tempranamente nuevos infectados entre los trabajadores de la salud (TS). Sobre 544 trabajadores con reacciones negativas, 275 aceptaron realizarse una nueva dosis de 2 UT de PPD al año siguiente. Se evaluaron enfermeras, médicos, técnicos, administrativos, bioquímicos, kinesiólogos, instrumentadoras, farmacéuticas, psicólogos y otros. Se consideró convertidor tuberculínico a aquel TS con reacción al PPD de 10 mm o mayores, al que se le indicó isoniazida a razón de 5 mg/kg una vez descartada tuberculosis en actividad. La media de edad fue de 45.6 ± 11.3 años y el sexo femenino constituyó el 76.3% de la muestra (210/275). Un 36.7% la integraron enfermeras (101/275), 17.7% fueron médicos, 14.9% técnicos, 10.9% administrativos, 5.1% bioquímicos y otros (14.5%). La tasa de conversión global fue de 8.3%, 11.8% en enfermeras, 10% en administrativos, 7.3% en técnicos, 7.1% en bioquímicos y 2% en médicos (p = NS). Se indicó isoniazida en 23 TS, con un cumplimiento del 52%. En el año de observación se denunciaron 8 casos nuevos de tuberculosis entre TS de nuestro hospital. La TCT en nuestro hospital es aún elevada, la actividad de enfermería es el grupo más vulnerable. Se considera ineludible la adopción de medidas de bioseguridad adecuadas.
Subject(s)
Humans , Male , Female , Adult , Hospitals, Municipal , Occupational Risks , Occupational Health/statistics & numerical data , Tuberculosis/epidemiology , Tuberculosis/prevention & control , Tuberculosis/transmissionABSTRACT
The objective of this work was to address the problem of tuberculosis (TB) infection among Health Care Workers (HCW), based on an experience in a TB Prevention and Treatment Programme at a General Acute Hospital in Buenos Aires City. The objectives of the programme were to provide health education and periodic screening of HCW, to detect TB cases and to implement control measures. TB infection was defined by a 10 mm reaction to 2 UT PPD. Two prevalence studies of TB infection were performed. In 1998 infection prevalence was 31.7% (n = 533), and in 2008 it was 35% (n = 670). Nurses presented the highest percentage. An increase in TB infection prevalence was observed in 2008 among physicians (p = 0.02). A sample of 45 HCW integrating the first prevalence study group was analysed by applying 2 UT PPD three month later. Eight tuberculin conversions were detected (17%), all of them in nurses; 163 HCW who had contact with other eight HCW who developed TB were evaluated, four of whom were nurses. PPD reactions were positive in 39.9% with no any new case of TB detected among them. In nurses, five tuberculin conversions were observed. Other 127 HCW from low risk areas were also evaluated, 25.9% of whom had positive reactions to 2 UT PPD, while this percentage was 39.9% in the previous group (p = 0.01).Despite the scarcity of human resources that limit the planning of TB incidence studies, personal protective measures, teaching HCW about TB and chemoprophylaxis might reduce the risk of TB in this group.
Subject(s)
Health Personnel/statistics & numerical data , Occupational Health/statistics & numerical data , Tuberculosis/epidemiology , Adult , Argentina/epidemiology , Cross Infection/transmission , Female , Health Personnel/education , Humans , Male , Personnel, Hospital/statistics & numerical data , Prevalence , Risk Factors , Tuberculin , Tuberculin Test , Tuberculosis/prevention & control , Tuberculosis/transmissionABSTRACT
El objetivo del presente trabajo fue abordar la problemática de la infección por tuberculosis (TB) en Trabajadores de la Salud (TS) a través de la experiencia en un programa de prevención y tratamiento de la TB en un Hospital General de Agudos de la Ciudad de Buenos Aires. Los objetivos del Programa fueron implementar acciones de educación para la salud, pesquisa periódica de TS, detección de casos de TB y efectuar acciones de control. Se definió infección TB como PPD 2 UT = 10 mm. Se realizaron dos estudios de prevalencia de infección. En 1998 fue de 31.7% (n = 533) y en 2008 de 35% (n = 670). Enfermería tuvo el mayor porcentaje de infectados. En 2008 se advirtió un aumento de la infección TB en los médicos (p = 0.02). Se estudiaron 45 TS en el grupo que repitió PPD a los tres meses del primer estudio de prevalencia. Se detectaron ochos virajes tuberculínicos (17%), todos en enfermeras. Se evaluaron 163 TS que estuvieron en contacto con 8 casos de TB diagnosticados en TS, 4 de los cuales eran enfermeras. El 39.9% presentó PPD positiva, no se detectaron casos nuevos de TB y se documentaron cinco conversiones tuberculínicas en enfermeras. Se evaluaron 127 TS de sectores con bajo riesgo, el 25.9% presentó PPD positiva (p = 0.01 comparando con el 39.9% en el grupo anterior). A pesar de las limitaciones en el recurso humano para realizar estudios de incidencia de TB, la protección personalizada, la educación en TB y la quimioprofilaxis podrían reducir los riesgos de TB en TS.
The objective of this work was to address the problem of tuberculosis (TB) infection among Health Care Workers (HCW), based on an experience in a TB Prevention and Treatment Programme at a General Acute Hospital in Buenos Aires City. The objectives of the programme were to provide health education and periodic screening of HCW, to detect TB cases and to implement control measures. TB infection was defined by a = 10 mm reaction to 2 UT PPD. Two prevalence studies of TB infection were performed. In 1998 infection prevalence was 31.7% (n = 533), and in 2008 it was 35% (n = 670). Nurses presented the highest percentage. An increase in TB infection prevalence was observed in 2008 among physicians (p = 0.02). A sample of 45 HCW integrating the first prevalence study group was analysed by applying 2 UT PPD three month later. Eight tuberculin conversions were detected (17%), all of them in nurses; 163 HCW who had contact with other eight HCW who developed TB were evaluated, four of whom were nurses. PPD reactions were positive in 39.9% with no any new case of TB detected among them. In nurses, five tuberculin conversions were observed. Other 127 HCW from low risk areas were also evaluated, 25.9% of whom had positive reactions to 2 UT PPD, while this percentage was 39.9% in the previous group (p = 0.01).Despite the scarcity of human resources that limit the planning of TB incidence studies, personal protective measures, teaching HCW about TB and chemoprophylaxis might reduce the risk of TB in this group.