Summary: Lax infection-control practices and inadequate isolation rooms were behind the tuberculosis outbreak at the Department of Veterans Affairs (VA) medical center in East Orange, New Jersey. Medical center staff did not consistently use appropriate procedures for isolating suspected or known tuberculosis patients. The center lacked a comprehensive employee-testing program to monitor the staff's exposure to active tuberculosis. Isolation rooms did not have proper airflow, and air exhausted from these rooms may have contaminated other areas in the medical center. Since the outbreak, the center has made major improvements in its infection-control practices, and VA plans to construct 19 isolation rooms at the center. VA has also tried to beef up tuberculosis controls at its other medical centers and is giving greater scrutiny to centers' tuberculosis-control programs and practices. According to a December 1992 VA survey, 10 medical centers each had more than 20 cases of tuberculosis; six of the 10 also had the highest numbers of AIDS cases.
