| Abstract
| - Abstract. Objective: To determine whether healthcare workers in England and Wales are at increased risk of tuberculosis and to examine the frequency of drug resistance in this population. Design: Comparison of notification rates by occupation obtained from national tuberculosis notification surveys in 1988 and 1993, with denominators from the 1991 census. Subjects: People with notified tuberculosis in professional and associate professional occupations from the two surveys. Main outcome measures: Rates of notified tuberculosis in health professionals (mainly doctors) and health associate professionals (mainly nurses) compared with rates in other professional and associate professional occupations, adjusted for ethnic group, sex, and age. Results: 119 cases of tuberculosis were identified in healthcare workers, including 61 nurses and 42 doctors. The crude notification rate in healthcare workers was 11.8 per 100 000 per year (95% confidence interval 9.8 to 14.1) compared with 3.3 per 100 000 per year (2.9 to 3.6) in other professional and associate professional occupations; rate ratios were higher (range 1.7 to 3.2) in all ethnic groups. The relative risk adjusted for ethnic group, sex, and age was 2.4 (95% confidence interval 2.0 to 3.0), slightly higher for health professionals (2.7 (1.9 to 3.8)) than for associate professionals (2.0 (1.5 to 2.6)). No multiple drug resistant strains of tuberculosis were identified in healthcare workers. Conclusions: Better detection and notification of cases of tuberculosis in healthcare workers may account for some of the apparent increased risk, but these findings imply that tuberculosis remains a hazard for healthcare workers and highlight the importance of ensuring that occupational health monitoring and protection workers are not neglected. Key messages. This study shows that rates of notified tuberculosis in healthcare workers in England and Wales were two to three times those in other socio- economically comparable occupational groups As many healthcare workers are unlikely to be exposed to tuberculosis infection, those who are may be at much greater risk than has been estimated No multiple drug resistant tuberculosis was found in healthcare workers It is important that health service commissioners and occupational health services are aware of the risks and ensure that the recommendations for the control of tuberculosis in health service staff and students are complied with
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