Working with HIV patients does not increase TB risk
September 1, 1999 3 minutes read
Working with HIV patients does not increase TB risk
Normal precautions provide sufficient protection
Health care workers need not fear contracting tuberculosis while working with a population of HIV-positive patients because their risk is no greater than when they work with a non-HIV patient population, according to a Veterans Affairs (VA) Medical Center researcher in Washington, DC.
"Basically, we found there was no obvious correlation between taking care of people who were HIV-positive and subsequent converting of TB," says Karen Zahnow, RN, MEd, research nurse for the VA Medical Center.
"It seems that providing direct medical or nursing care to HIV patients did not increase an individual’s risk of acquiring TB infection," Zahnow adds. "There was a slight trend toward a conversion rate of health care workers who cared for people with new tuberculosis, which makes sense."
However, even this trend was not the result of whether the person with TB also had HIV infection, she says.
The study’s results mean that health care workers who treat HIV patients need only use the same TB protection guidelines they would use if they were working with a non-HIV population. (See TB guidelines for health care workers, inserted in this issue.)
"If we’re suspicious of TB infection, then we look for it and rule it out, and the appropriate infection and control measures work," Zahnow says. "It was a relief to my co-workers to know that so long as we’re paying attention and don’t let our guard down when the appropriate safety measures are in place, then we’re OK."
Some facilities, however, will want to take additional steps to discover whether or not HIV patients have TB, because HIV patients are more susceptible to TB infection. Zahnow says her hospital’s policy is that anyone who is HIV-positive and has a chest infection automatically will be tested for TB.
The study, which began in 1992, resulted from a grant from the National Institutes of Health and its network of 17 hospitals, clinics, and private physicians who treat HIV-infected people. The network is called the Terry Beirn Community Programs for Clinical Research on AIDS.
Staff and volunteers at 16 of the Terry Beirn sites participated in the observational study, submitting information about the number of patients seen with HIV or TB. A total of 1,014 health care workers were enrolled. About half of those enrolled averaged 10 or more hours per week of direct hands-on care of patients, including physical examinations. They completed a questionnaire, which could be submitted anonymously, and identified themselves as HIV-positive or -negative, unaware of HIV status, or unwilling to answer the question.1
One in five health care workers had TB
About 21% (209) of the health care workers had a history of TB or a positive tuberculin skin test. Of 201 workers who had a positive tuberculin skin test, 157 had information about when they became positive, when they entered the health care field, and the amount of time they worked with HIV patients.
Of the 157, 25% tested positive before working in health care; 25% tested positive after entering health care but before working with HIV-infected patients; and the remaining 50% had become infected after working with HIV patients.
The 805 workers who had no history of TB or a positive skin test received a baseline purified protein derivative (PPD) tuberculin skin test. This resulted in 39 workers testing positive and 766 workers testing negative.
• During the course of the study, 22 of the 766 workers followed with skin-testing each six months converted their PPD or received TB prophylaxis. This produced a rate of 1.8 per 100 person-years of follow-up.
• The study concluded that there was no apparent relation between caring for HIV-infected people and the rate of PPD conversion among the health care worker cohort. However, those who performed cough-inducing procedures had tendencies toward higher conversion rates than those who didn’t, but without correlation to the HIV status of the patients.
Reference
1. Zahnow K, Matts JP, Hillman D, et al. Rates of tuberculosis infection in healthcare workers providing services to HIV-infected populations. Infect Control Hosp Epidemiol 1998; 19:829-835.
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