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Hazards to the orthopaedic trauma surgeon: occupational exposure to tuberculosis. Risk reduction, testing, and treatment (a review article).

Infection with tuberculosis (TB) in the United States has risen over the last decade. In the past 5 years, health care worker exposure to multidrug-resistant TB has lead to more than 100 skin-test conversions, 17 cases of active TB, and at least six deaths. As with human immunodeficiency virus, hepatitis B virus, and hepatitis C virus, the orthopaedic traumatologist is at risk of exposure and infection because, in many cases, the medical histories of patients encountered in the trauma bay cannot be determined until well into the course of care. Risk depends principally on two factors: (a) likelihood of exposure (large urban settings, prisons, concentration of persons from countries with high TB prevalence), and (b) immune status of the surgeon. Prompt recognition, isolation, and appropriate treatment of patients with infectious TB; engineering controls; and the use of personal protective respiratory equipment can help prevent the transmission of TB to health care workers.