Reports on HIV/AIDS: 1990

MAY 18, 1990, MMWR, Vol. 39, RR-8: [inclusive page numbers]
Prison authorities have primary responsibility for implementing these programs,
but health departments can and should play an important advisory and regulatory
role. Health departments should routinely monitor and evaluate tuberculosis control
activities in prisons.
Nursing homes/facilities for the elderly
Among all racial and ethnic groups and both sexes, tuberculosis case rates
increase with increasing age. Nursing home residents have an incidence of disease
from two to seven times higher than demographically similar persons living in other
settings. Recent studies have documented unsuspected transmission of tuberculous
infection in nursing homes/facilities that presents a risk to workers as well as to
residents (12).
Health-care facilities
The risk to hospital workers, other institutional health-care workers, and home
health-care workers is lower today than in the prechemotherapy era. The principal
contributors to reducing infectiousness are a lower incidence of tuberculosis in the
population and the potency of modern chemotherapy regimens. However, the risk to
health-care workers may still be substantial. The main risk is exposure to patients with
unsuspected tuberculosis. This poses a particular problem when the clinical presentation is atypical, as is often the case when elderly patients or patients with HIV
infection are involved. Procedures that induce coughing, such as sputum induction
and aerosolized pentamidine treatments, may present a particular hazard to healthcare workers (3).
Tuberculin skin testing upon employment should be mandatory for all persons
who work in these environments. Health administrators and infection control departments in hospitals are responsible for ensuring that these recommendations are
implemented.
Repeat screening of persons in risk groups
The need for repeat skin testing should be determined by the likelihood of
exposure to infectious tuberculosis. All tuberculin-negative individuals in high-risk
groups should be retested if exposure to an infectious case occurs. In some
institutional and group-living environments (e.g., hospitals, prisons, nursing homes,
shelters for the homeless), the risk of exposure is probably high enough to justify
repeat testing at 6- to 24-month intervals. Local health officials should make these
decisions by using locally generated data.
ROLE OF HEALTH DEPARTMENTS
Health departments should identify and establish working relationships with
persons providing health-care services to high-risk populations and should assist
them in developing and instituting screening programs appropriate for the situation.
Specifically, health departments should:
* Assist in training staff to perform, read, and record tuberculin skin tests; to
evaluate positive tuberculin reactors for clinical tuberculosis and preventive
therapy; to provide preventive therapy and monitor for compliance and adverse

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