Are healthcare workers in England and Wales at increased risk of tuberculosis?
BMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7056.522 (Published 31 August 1996) Cite this as: BMJ 1996;313:522
- Sarah Meredith (sarah.meredith{at}mcmail), lecturer in public healtha,
- John M Watson, consultant epidemiologistb,
- Kenneth M Citron, consulting physicianc,
- Anne Cockcroft, consultant in occupational healthd,
- Janet H Darbyshire, heade
- a Department of Epidemiology and Medical Statistics, London Hospital Medical College, London E1 4NS,
- b Public Health Laboratory Service Communicable Disease Surveillance Centre, London NW9 5EQ,
- c Royal Brompton Hospital, London SW3 6NP,
- d Royal Free Hospital and School of Medicine, London NW3 2QG,
- e Medical Research Council HIV Clinical Trials Centre, University College London Medical School, London WC1E 6AU
- Correspondence to: Dr Sarah Meredith, Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232-2637, USA.
- Accepted 27 June 1996
Abstract
Objective: To determine whether healthcare workers in England and Wales are at increased risk of tuberculosis and to examine the frequency of drug resistance in this population.
Design: Comparison of notification rates by occupation obtained from national tuberculosis notification surveys in 1988 and 1993, with denominators from the 1991 census.
Subjects: People with notified tuberculosis in professional and associate professional occupations from the two surveys.
Main outcome measures: Rates of notified tuberculosis in health professionals (mainly doctors) and health associate professionals (mainly nurses) compared with rates in other professional and associate professional occupations, adjusted for ethnic group, sex, and age.
Results: 119 cases of tuberculosis were identified in healthcare workers, including 61 nurses and 42 doctors. The crude notification rate in healthcare workers was 11.8 per 100 000 per year (95% confidence interval 9.8 to 14.1) compared with 3.3 per 100 000 per year (2.9 to 3.6) in other professional and associate professional occupations; rate ratios were higher (range 1.7 to 3.2) in all ethnic groups. The relative risk adjusted for ethnic group, sex, and age was 2.4 (95% confidence interval 2.0 to 3.0), slightly higher for health professionals (2.7 (1.9 to 3.8)) than for associate professionals (2.0 (1.5 to 2.6)). No multiple drug resistant strains of tuberculosis were identified in healthcare workers.
Conclusions: Better detection and notification of cases of tuberculosis in healthcare workers may account for some of the apparent increased risk, but these findings imply that tuberculosis remains a hazard for healthcare workers and highlight the importance of ensuring that occupational health monitoring and protection workers are not neglected.
Key messages
This study shows that rates of notified tuberculosis in healthcare workers in England and Wales were two to three times those in other socio- economically comparable occupational groups
As many healthcare workers are unlikely to be exposed to tuberculosis infection, those who are may be at much greater risk than has been estimated
No multiple drug resistant tuberculosis was found in healthcare workers
It is important that health service commissioners and occupational health services are aware of the risks and ensure that the recommendations for the control of tuberculosis in health service staff and students are complied with
Footnotes
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Funding The national survey of notifications of tuberculosis in England and Wales in 1988 was funded by the Medical Research Council. The Public Health Laboratory Service, British Thoracic Society, and the Department of Health collaborative survey of 1993 was funded by the Department of Health. No additional funds were received for this study.
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Conflict of interest None.
- Accepted 27 June 1996