FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 331:169-173 July 21, 1994 Number 3 Next

	Full Text Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background After outbreaks of multidrug-resistant tuberculosis, the Centers for Disease Control and Prevention proposed the use of respirators with high-efficiency particulate air filters (HEPA respirators) as part of isolation precautions against tuberculosis, along with a respiratory-protection program for health care workers that includes medical evaluation, training, and tests of the fit of the respirators. Each HEPA respirator costs between $7.51 and $9.08, about 10 times the cost of respirators currently used.

Methods We conducted a cost-effectiveness analysis using data from the University of Virginia Hospital on exposure to patients with tuberculosis and rates at which the purified-protein-derivative (PPD) skin test became positive in hospital workers. The costs of a respiratory-protection program were based on those of an existing program for workers dealing with hazardous substances.

Results During 1992, 11 patients with documented tuberculosis were admitted to our hospital. Eight of 3852 workers (0.2 percent) had PPD tests that became positive. Five of these conversions were believed to be due to the booster phenomenon; one followed unprotected exposure to a patient not yet in isolation; the other two occurred in workers who had never entered a tuberculosis isolation room. These data suggest that it will take more than one year for the use of HEPA respirators to prevent a single conversion of the PPD test. Assuming that one conversion is prevented per year, however, it would take 41 years at our hospital to prevent one case of occupationally acquired tuberculosis, at a cost of $1.3 million to $18.5 million.

Conclusions Given the effectiveness of currently recommended measures to prevent nosocomial transmission of tuberculosis, the addition of HEPA respirators would offer negligible protective efficacy at great cost.

Source Information

From the University of Virginia Health Sciences Center, Box 473, Charlottesville, VA 22908, where reprint requests should be addressed to Dr. Farr.

Full Text of this Article

Related Letters:

HEPA Respirators and Tuberculosis in Hospital Workers
Sobel E., Sherertz R. J., Streed S. A., Brown V., Bishop C., Rutala W. A., Weber D. J., Adal K. A., Anglim A. M., Farr B. M.
Extract | Full Text  
N Engl J Med 1994; 331:1658-1660, Dec 15, 1994. Correspondence

This article has been cited by other articles:

• Wisnivesky, J. P., Henschke, C., Balentine, J., Willner, C., Deloire, A. M., McGinn, T. G. (2005). Prospective Validation of a Prediction Model for Isolating Inpatients With Suspected Pulmonary Tuberculosis. Arch Intern Med 165: 453-457 [Abstract] [Full Text]  
• Menzies, D., Fanning, A., Yuan, L., FitzGerald, J. M., the Canadian Collaborative Group in Nosocomial Tra, (2000). Hospital Ventilation and Risk for Tuberculous Infection in Canadian Health Care Workers. ANN INTERN MED 133: 779-789 [Abstract] [Full Text]  
• Menzies, D., Fanning, A., Yuan, L., Fitzgerald, M. (1995). Tuberculosis among Health Care Workers. NEJM 332: 92-98 [Full Text]  
• Sobel, E., Sherertz, R. J., Streed, S. A., Brown, V., Bishop, C., Rutala, W. A., Weber, D. J., Adal, K. A., Anglim, A. M., Farr, B. M. (1994). HEPA Respirators and Tuberculosis in Hospital Workers. NEJM 331: 1658-1660 [Full Text]