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Interventions taken at a homeless shelter to reduce transmission of tuberculosis.

Coffey C; Calvert C; Duling M; Hudnall J; Lawrence R; Martin S
American Industrial Hygiene Conference and Exposition, May 21-26, 2005, Anaheim, California. Fairfax, VA: American Industrial Hygiene Association, 2005 May; :70
The National Institute for Occupational Safety and Health (NIOSH) provides technical assistance to internal and external partners regarding hazardous worksite exposures. NIOSH engineers and scientists responded to a request from the National Center for HIV, STD and TB Prevention and the Missouri Department of Health and Senior Services (DHSS) concerning a tuberculosis (TB) outbreak at the Salvation Army Harbor Light facility in St. Louis, Missouri. Harbor Light is a shelter open to any adult male without a place to sleep. The shelter has three major components: 1) the drug treatment area, 2) the respite program, and 3) the transient, open-to-the-public program. The sleeping quarters in the main building house about 100 clients. The shelter has an "annex" in a neighboring building with sleeping quarters on two floors. Since 2000, there had been 19 confirmed cases of TB at the shelter, with two deaths. Of these 19 cases, 14 were epidemiologically linked to Harbor Light shelter use, in particularly the Annex. Eight infected contacts were also linked. As a result of the findings, NIOSH made several recommendations to aid in the prevention of continuing TB transmission, including: improving shelter administrative practices (e.g., routine sign and symptoms review, chest x-rays, purified protein derivative tuberculin skin tests, and sputum screening) so that suspect clients are more readily identified, tested and isolated; thoroughly cleaning and balancing all heating, ventilating and air-conditioning systems and updating/retrofitting each to include Minimum Efficiency Reporting Value 14 filters, and installing in-duct and upper air Ultraviolet Germicidal Irradiation fixtures. The implementation of these preventative measures gave the shelter an effective filtration rate of about 98 percent for airborne mycobacterium tuberculosis. Since these improvements were made, no new tuberculosis transmission has occurred at the shelter that assists about 1,800 homeless clients per year.
Diseases; Disease-transmission; Disease-prevention; Disease-control; Demographic-characteristics; Sex-factors; AIDS; AIDS-virus; Age-factors; Age-groups; HIV; Heating-systems; Ventilation-systems; Air-conditioning; Filters; Filtration; Infectious-diseases; Infection-control; Pulmonary-system-disorders; Respiratory-system-disorders
Publication Date
Document Type
Fiscal Year
NIOSH Division
Priority Area
Work Environment and Workforce: Indoor Environment
Source Name
American Industrial Hygiene Conference and Exposition, May 21-26, 2005, Anaheim, California
Page last reviewed: September 2, 2020
Content source: National Institute for Occupational Safety and Health Education and Information Division