Tuberculosis in Health Care Professionals: Assessing and Accepting the Risk

Tuberculosis has long been an accepted hazard of work in the health professions [1]. For decades, however, physicians of the era after World War II did not take the hazard seriously. I recall an attending physician who, during hospital rounds on a patient with pulmonary tuberculosis in the late 1960s, stated that he would rather have tuberculosis than a broken arm, so easy and painless had the curative treatment of tuberculosis become.

That casual attitude changed abruptly in the early 1990s. Multidrug-resistant tuberculosis, the most ominous sequel to the now decade-long resurgence of tuberculosis in the United States, arrived on the scene, along with the confluence of tuberculosis, human immunodeficiency virus (HIV) infection, homelessness, and drug abuse [2, 3]. Multidrug-resistant tuberculosis is at best difficult to cure, and its treatment involves long-term, costly, and toxic drug therapy and, frequently, surgery [4]. At worst, in patients with HIV infection, it is a rapidly progressive, untreatable, and fatal infection [2, 3].

Many health care workers have probably been infected with the multidrug-resistant form during nosocomial outbreaks; some have died [5]. Because of concern over this “new” occupational risk, the U.S. Occupational Safety and Health Administration (OSHA) recently included tuberculosis among workplace hazards that can seriously harm or kill employees and mandated that health care institutions take the steps needed to eliminate employees' risk for tuberculosis.

The article by Fagan and Poland [6] in this issue offers disquieting information on the current risk for tuberculosis in one group of …