Transmission of Mycobacterium tuberculosis from Medical Waste

Details

• Personal Author:
  Bell TA ; Boudreau AY ; Braden CR ; Cairns KL ; Colombel AC ; Field KW ; Johnson KR ; Morlock GP ; Onorato IM ; Stehr-Green PA ; Valway SE ; Weber, Angela M. ; Woodley CL ; Yang ZH
• Description:
  Context: Washington State has a relatively low incidence rate of tuberculosis (TB) infection. However, from May to September 1997, 3 cases of pulmonary TB were reported among medical waste treatment workers at 1 facility in Washington. There is no previous documentation of Mycobacterium tuberculosis transmission as a result of processing medical waste. Objective: To identify the source(s) of these 3 TB infections. Design, Setting, and Participants: Interviews of the 3 infected patient-workers and their contacts, review of patient-worker medical records and the state TB registry, and collection of all multidrug-resistant TB (MDR-TB) isolates identified after January 1, 1995, from the facility's catchment area; DNA fingerprinting of all isolates; polymerase chain reaction and automated DNA sequencing to determine genetic mutations associated with drug resistance; and occupational safety and environmental evaluations of the facility. Main Outcome Measures: Previous exposures of patient-workers to TB; verification of patient-worker tuberculin skin test histories; identification of other cases of TB in the community and at the facility; drug susceptibility of patient-worker isolates; and potential for worker exposure to live M tuberculosis cultures. Results: All 3 patient-workers were younger than 55 years, were born in the United States, and reported no known exposures to TB. We did not identify other TB cases. The 3 patient-workers' isolates had different DNA fingerprints. One of 10 MDR-TB catchment-area isolates matched an MDR-TB patient-worker isolate by DNA fingerprint pattern, DNA sequencing demonstrated the same rare mutation in these isolates. There was no evidence of personal contact between these 2 individuals. The laboratory that initially processed the matching isolate sent contaminated waste to the treatment facility. The facility accepted contaminated medical waste where it was shredded, blown, compacted, and finally deactivated. Equipment failures, insufficient employee training, and respiratory protective equipment inadequacies were identified at the facility. Conclusion: Processing contaminated medical waste resulted in transmission of M tuberculosis to at least 1 medical waste treatment facility worker. [Description provided by NIOSH]
• Subjects:
  Communicable Diseases Health Care Facilities Workforce And Services Health Personnel Occupational Health Respiratory Tract Diseases Safety
• Keywords:
  Control-methods Control-technology Disease-prevention Disease-transmission Health-care-facilities Health-care-personnel Health-protection Infectious-diseases Medical-screening Pulmonary-system-disorders Respiratory-system-disorders

  More +
• ISSN:
  0098-7484
• Document Type:
  Text
• Genre:
  Journal Article
• Place as Subject:
  Arkansas ; Colorado ; Georgia ; Ohio ; OSHA Region 10 ; OSHA Region 4 ; OSHA Region 5 ; OSHA Region 6 ; OSHA Region 8 ; Washington
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  DSHEFS - Division of Surveillance, Hazard Evaluations, and Field Studies
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  284
• Issue:
  13
• NIOSHTIC Number:
  nn:20032348
• Citation:
  JAMA 2000 Oct; 284(13):1683-1688
• Contact Point Address:
  Kammy Johnson, DVM, PhD, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS E-23, Atlanta, GA 30333
• Email:
  kdj8@cdc.gov
• Federal Fiscal Year:
  2001
• Peer Reviewed:
  True
• Source Full Name:
  Journal of the American Medical Association
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:ddabc62b8b2f98fe9fcb398159da612974f1def8192c0b1b3a2e73fdc70721e6436abf3d5c0912e9fabe7c59e2a7cdcb4eb4c4dcbd15b0a8bf400cc6ec758bcb
• Download URL:
  https://stacks.cdc.gov/view/cdc/186364/cdc_186364_DS1.pdf
• File Type:
  [PDF - 132.91 KB ]