Many hospitals aren't adequately prepared to prevent the spread of tuberculosis, a new survey indicates.
That concerns analysts because the nation's hospitals soon may face strict new federal guidelines that may force them to spend millions of dollars to meet requirements for TB prevention.
"Hospitals want to make sure they are spending their healthcare dollars wisely, so they are being cautious about how to deal with the epidemic," said Gina Pugliese, director of infection control at the American Hospital Association. The AHA co-sponsored the survey of 763 hospitals with the national Centers for Disease Control and Prevention.
Nearly 30% of hospitals surveyed didn't have isolation rooms that meet CDC criteria, and 89% of hospital emergency departments didn't have isolation facilities, the survey found (See chart).
Ms. Pugliese has been explaining federal TB guidelines, and ways hospitals can deal with them, at healthcare facilities around the country. Of those responding to the survey, 88% of the hospitals had admitted TB patients.
Healthcare organizations such as the American Hospital Association and the American Medical Association have accused the CDC of issuing TB guidelines that are too onerous (Dec. 20, 1993, p. 24). Other government agencies, such as the Occupational Safety and Health Administration, typically use CDC guide lines as a base for their infection-control poli cies.
"Hospitals were not ready for this TB epidemic when we had a steady decline in TB cases until 1985," Ms. Pugliese said. "When we saw a decline in TB, we shifted our resources to AIDS and HIV. And now we are dealing with that and seeing more of an influx of homeless and immigrants with TB."
Hospitals need to have concrete, scientific data before they embark on spending several millions of dollars for new ventilation systems to deal with the TB epidemic, Ms. Pugliese said. For example, one hospital estimated it would have to spend $50,000 to $150,000 per room to improve ventilation associated with care for TB patients.
The report cites examples of spending that range from $1.5 million to more than $5 million per facility. However, the report doesn't contain any statistical information on such expenditures.
Ms. Pugliese said hospitals are doing a good job in many areas, such as skin-testing programs. The survey showed 99% of hospitals have such programs.