94-07-26 Proposed changes in the Center for Disease Control

                             RELEASE ON RECEIPT

                                       Contact: Marguerite Beck
     Charlottesville, Va., July 26 --Proposed changes in the Center
for Disease Control and Prevention (CDC) guidelines to prevent the
spread of tuberculosis in hospitals would cost millions of dollars
and provide little protection to health care workers, according to
a study published in this week's New England Journal of Medicine.
     The study, done by researchers at the University of Virginia
Health Sciences Center, suggests that the proposed procedures would
add very little protection beyond current methods. Using U.Va.
Medical Center as a case study, researchers estimate that it would
take these new procedures at least 41 years and possibly longer to
prevent a single case of tuberculosis in an employee.
     The cost estimates for using these new procedures for 41 years
in this one hospital range from $1.3 million to $18 million to
prevent a single case.
     "This is directly counter to the Clinton administration's
attempt to reduce the costs of health care," said Dr. Barry Farr,
hospital epidemiologist and associate professor of medicine at
U.Va.
     "It would be irresponsible to require hospitals to use a
procedure that has no scientific documentation of effectiveness and
could waste millions of health care dollars. Unfortunately, the
Occupational Safety and Health Administration is already
implementing these changes."
     U.Va. researchers conducted the study after the CDC published
guidelines for
public review and comment in October 1993 that would require all
health care facilities to
augment current procedures for protecting staff from tuberculosis.
The new guidelines would require health care workers to use
sophisticated high-efficiency particulate air filter (HEPA)
respirators instead of simple isolation masks. Medical evaluation,
training and fit
testing would be required for workers before their use of these
respirators.
     According to Farr, no studies were conducted before the  new
measures were proposed to show that they would result in better
protection of health care workers.
     The simple isolation masks used until recently by all
hospitals cost less than $2,000 for an entire year of  tuberculosis
isolation at the U.Va. Medical Center. By contrast, HEPA filter
respirators and the accompanying respiratory protection program
could cost more than 100 times as much, Farr said.
     Current methods of protection recommended by the CDC, which
have been used successfully for decades, include administrative and
engineering controls. Administrative policies requires that
patients identified with possible tuberculosis must be placed in
isolation rooms to prevent the disease from spreading.
     Engineering controls include special ventilation systems that
exhaust all air from the isolation room at least six times per hour
and that balance air flow so that air from the isolation room
cannot flow into a hallway where passersby might be exposed, Farr
explained. Some hospitals also use ultraviolet lamps in the
isolation room to kill the tuberculosis bacteria.
     Farr said that outbreaks of multidrug resistant tuberculosis
in New York and Florida several years ago spurred the recent CDC
draft guidelines. The outbreaks occurred in hospitals not complying
with previous CDC recommendations for administrative and
engineering controls and were controlled without the use of HEPA
respirators.
     U.Va. operated a separate tuberculosis hospital from 1979 to
1987. During those
eight years, 762 patients with actively contagious pulmonary or
laryngeal tuberculosis received in-patient treatment using the
administrative and engineering controls previously recommended by
the CDC. No outbreaks were observed among university employees
despite annual skin tests for detecting exposure to tuberculosis.
     "This epidemiological record of safety using conventional
controls  over an extended period of time indicates that expensive,
untested proposed measures are unnecessary," Farr said.
                               ###
                                                    July 26, 1994

Charlotte A. Buttner, Program Support Technician, Health Sciences
Center News Services, McKim Hall Room 3118, #429, Charlottesville,
Virginia, 22908, 804-924-5679, cab2j@virginia.edu
CompuServe 72203,1033


[Submitted by:  (cab2j@dmt03.mcc.virginia.edu)
               27 Jul 94 09:04:31 EDT]