Tuberculin skin test conversion rates in New York City emergency medical service health care workers

Objective: To determine annual tuberculin skin test conversion (infection) rates for prehospital health care workers (EMTs and paramedics) in an urban environment with a high prevalence of Mycobacterium tuberculosis. Methods: We conducted a prospective study of prehospital health care workers for the New York City EMS, EMS Employee Health Service, and the Fire Department Bureau of Health Service to determine the tuberculin skin test conversion rates. In 1992, all current and new EMS prehospital health care workers without a known history of a positive tuberculin reaction received a baseline tuberculin purified protein derivative (PPD) skin test. Thereafter, (January 1, 1993-December 31, 1996) all EMS health care workers who had negative PPD skin test results received annual tuberculin PPD skin tests. Tuberculin skin test conversion was defined as induration of 10 mm or greater in a worker with a documented prior negative test result. The PPD skin test reaction was measured by trained professional readers. Results: A total of 7,290 PPD test results were read during this study. Compliance with annual testing was 75%. Annual tuberculin skin test conversion rates were 1.3% in 1993, .7% in 1994, .1% in 1995, and .2% in 1996 (average .5%). In a static subgroup with at least 15 years' seniority, compliance with annual testing was 100% and annual tuberculin skin test conversion rates were .5% in 1993, 0 in 1994, .5% in 1995, and 1.5% in 1996 (average .6%). Conclusion: Despite the high prevalence of M tuberculosis infection in New York City and the potential for difficulty in the use of respiratory precautions during emergency response operations, EMS prehospital health care workers have an annual tuberculin conversion rate that is relatively low compared with hospital-based health care workers.