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- W1987526726 abstract "In this issue of Infection Control and Hospital Epidemiology, a potpourri of tuberculosis (TB)related articles are being published.1-7 Tuberculosisrelated issues have been an important focus for the past decade for those in infection control and hospital epidemiology, especially in urban areas where the large majority of TB cases occur,8 but also, because of federal regulations, for those in low-endemic areas or areas where no TB cases occur (approximately half of the counties in the United States). The resurgence of TB beginning in the mid1980s in the United States (in large part, due to failure and underfunding of the public health infrastructure and to the epidemic of human immunodeficiency virus [HIV] infection) and outbreaks of TB have highlighted the risk of nosocomial transmission of TB.9,1o These outbreaks affected both healthcare workers (HCWs) and patients. The fact that outbreaks in New York and Miami, among others, involved multidrug-resistant (MDR) strains that were associated with high morbidity and mortality among HIV-infected individuals punctuated the importance of effective TB infection control measures. Commingling of patients with unsuspected TB and those who were quite immunosuppressed led to amplification of nosocomial transmission. A decade ago, few institutions were prepared for the changing epidemiology of TB. Several recent studies have demonstrated that infection control measures are effective in preventing nosocomial transmission of TB,11-13 and two reports in this issue, from institutions in Kentuckyl and New York,2 provide additional data on decreases in HCW tuberculin skin-test (TST) conversions following implementation of TB infection control measures. In most studies, multiple interventions (administrative controls, environmental controls, and respiratory pr tection) were initiated at approximately the same time, making it more difficult to identify the most crucial aspect of the program. The importance of TB infection control measures in contributing to the decline in TB cases in the United States, as well as the eduction in the number of MDR-TB cases in New York City, often has been understated. I reased federal funding for TB control activities and expansion of directly observed therapy clearly are important in efforts to prevent TB, but the initial decline in TB cases and in MDR TB in the United States beginning in 1993 likely was due, in large part, to interruption of TB transmission within healthcare facilities. Unfortunately, increased funding for TB control in the United States in the last 5 years often has not trickled down to inner-city hospitals, which frequently are the first line in the battle against TB. From our experience and that of others, it appears clear that administrative controls are the most important component of a TB infection control program. At Grady Memorial Hospital in Atlanta, we were able to decrease TB exposure episodes markedly and concomitantly to decrease HCW TST conversions after implementing an expanded respiratory isolation policy.11 We continue to isolate appropriately" @default.
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- W1987526726 date "1997-08-01" @default.
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- W1987526726 title "Tuberculosis and Infection Control: What Now?" @default.
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- W1987526726 doi "https://doi.org/10.1086/647668" @default.
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