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Hospitals urged to follow stricter TB precautions

After two years of revisions and debate, the Centers for Disease Control and Prevention is pressing hospitals to adopt stricter guidelines to curb the spread of tuberculosis.

The changes were prompted by an increasing number of tuberculosis patients who don't respond to drug treatment, and by outbreaks in hospitals and prisons.

The guidelines call for the use of masks that block smaller particles than the type now used and for the use of ultraviolet light to kill airborne tuberculosis germs. Standards for ventilation and hospital record-keeping also were tightened.

"This is an important step in providing protection in a place of very great risk," said Dr. Alan Hinman, director of the CDC's National Center for Prevention Services.

The guidelines _ which apply to hospitals, prisons, medical and dental offices and nursing homes _ will be issued today and give the Centers for Disease Control a way to tackle the problem of drug resistance, which Hinman called "one of the scariest aspects of TB."

The American Hospital Association, which was critical of previous proposals, wouldn't comment until it has a copy of the final standards.

Tuberculosis declined in the United States for 30 years until 1985, when it began to skyrocket, mostly because of AIDS sufferers' susceptibility and an increase in immigrants carrying the infection.

Active TB is spread by coughing or sneezing but is usually treatable. In recent years, however, drug-resistant strains have developed. About 1,500 people died of TB in the United States last year.

Initially, the Centers for Disease Control recommended that workers wear battery-powered hoods and masks when caring for people who have infectious TB. The masks are considered cumbersome and expensive. After an outpouring of criticism, the center decided on masks that are cheaper than the battery version. Some hospitals already use the recommended masks.

The new guidelines are flexible, Hinman said. Hospitals in areas where tuberculosis is rare won't have to follow as many guidelines as those in areas where it is more common, such as New York City.