Infection Control & Hospital Epidemiology


343


Fig. 1. (Continued)


most are from a high-TB-burden country). Existing HCWs were categorized according to the risk of exposure to TB based on their area of work (high- versus low-risk areas; which were mutually exclusive, assuming that HCWs do not work in >1 area concomi- tantly). High-risk areas were classified as emergency medicine, radiology, respiratory, general medicine, hematology-oncology, microbiology or pathology laboratories, medical intensive care or transplant units, based on the likelihood of encountering unrec- ognized pulmonary TB, performing aerosol-generating proce- dures, or encountering infectious specimens.13–15 Further assumptions included the following: (1) all HCWs had


normal chest x-rays at each screening time point; (2) HCWs diag- nosed withLTBI would be adherent to 6months of isoniazid (INH) treatment; (3) no deaths and no transmission or recurrent TB; and (4) a stable level of occupational risk during the time horizon of 3 years.


Screening strategies


Based on discussion with hospital stakeholders regarding consid- erations of feasibility and acceptability, we considered the follow- ing screening strategies for new and current employees with levels of risk stratification (Table 1).


(1) “No screening” (current approach): No HCWs undergo screening for LTBI.


(2) “New”: All newly hired HCWs undergo a triennial screening at the time of employment.


(3) “New international þ triennial high-risk”: Newly hired international staff undergo mandatory LTBI screening, while


existing staff working in high-risk areas are screened once every 3 years. Partial adherence to screening among existing staff is assumed.


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