1.To determine the risk of nosocomial transmission of Mycobact-
erium tuberculosis among health care workers (HCWs) and nurs-
ing/medical students on Taiwan.
2.To describe risk factors for tuberculin skin test (TST) posi-
tivity among HCWs and nursing/medical students on Taiwan.
3.To determine the prevalence of TST conversion among the nurs-
ing/medical students on Taiwan before and after their patient
4.To evaluate the effectiveness of current infection control p-
rocedures in hospitals on Taiwan for tuberculosis (TB).
5.To assess and implement institution-specific TB infection pr-
evention interventions on Taiwan.
The activities described in this Implementing Arrangement will
be carried out under the general terms and conditions establi-
shed between the American Institute in Taiwan (AIT) and the C-
oordination Council for North American Affairs; since renamed
the Taipei Economic and Cultural Representative Office in the
United States (TECRO), in the Guidelines for a Cooperative Pr-
ogram in Public Health and Preventive Medicine, hereinafter r-
eferred to as the Guidelines. This Implementing Arrangement is
hereby attached the Guidelines and becomes part of the Guidel-
The topic coordinator for the activities described in this Im-
plementing Arrangement is:
William R. Jarvis, M.D.
Chief, Epidemiology Branch
Hospital Infections Program
National Center for Infectious Diseases
Centers for Disease Control and Prevention
AIT, through its designated representative the Centers for Di-
sease Control and Prevention (CDC), will provide the following
1.Technical assistance in preparing study protocol and data co-
llection forms, supervision of data collection, data analysis
, and manuscript preparation.
2.Training to hospital staff on method of administering TSTs,
reading TSTs, and interpretina TSTs.
3.Technical assistance in developing health-care worker educat-
ional materials to improve health-care worker understanding
of TB transmission and methods to reduce transmission risk.
4.Technical assistance in assessing current TB infection contr-
ol practices and making recommendations for possible improve-
ments through administrative, engineering, and personal prot-
In Year One, th services described in B. above, will be provi-
ded in connection with the following plan:
1.Initiate the study at Veterans General Hospital and Chang Gu-
ng Memorial Hospital which consists of a) cross-sectional TST
survey of HCWs and medical/nursing students; b) medical eval-
uation of HCWs and medical/nursing students suspected to have
active TB; c) TB risk assessment of selected wards/areas of
each hospital; d) review of administrative and engineering c-
ontrol measures in the two hospitals.
Two person CDC team, 1 trip @ 4-6 weeks/trip
2.Assist with TST data analysis and interpretation.
No trip - communicate via e-mail and fax.
In Year Two (6-12 months after Year One activities are comple-
ted), the services described in B. above, will be provided in
connection with the following plan:
1.Based upon the risk of M. tuberculosis infection determined
in Year One, appropriate hospital- and ward-specific prevent-
ion interventions will be implemented at the two hospitals.
Two person CDC team, I trip @ 2-4 weeks
2.6-22 months after the intervention is implemented, HCWs and
medical/nursing students who were TST-negative during the Ye-
ar One assessment will be retested, the rish: of M. tubercul-
osis Infection will be assessed, and the efficacy of the int-
ervention detennined. In addition, new HCWs and medical/nurs-
ing students (not present for the initial testing) will be i-
ncluded in the TST survey.
Two person CDC team, 1 trip @ 2-4 weeks.
In Years Three Through Five, the services described in B. abo-
ve, will be provided in connection with the following plan:
1.Each year (Years 3, 4 and 5), all HCWs and medical/nursing s-
tudents who were TST-negative at the previous test will be r-
etested. In each of these years, new HCWs and medical/nursing
students (who have not been present or tested in the previous
TST surveys) will be included in the TST survey.
Two person CDC team, 1 trip each year @ 2-4 weeks.
The cost for the activity described in the Implementation Plan
for Year One of this Implementing Arrangement is mutually agr-
eed not to exceed U.S. $15,000. Costs for Years 2-5 will be a-
greed upon mutually by the Parties. TECRO shall pay all costs
associated with services provided to it, its designated repre-
sentatives, the Department of Health, the Veterans General Ho-
spitaf, and the Chang Gung Memorial Hospital, or to other org-
anizations in the territory TECRO represents in a manner cons-
istent with the Guilines.
D.INTELLECTUAL PROPERTY CONSIDERATIONS
There are no intellectual property rights (IPR) expected to a-
rise in conjunction with activities described in this Impleme-
nting Arrangement. TECRO and its designated representatives,
the Department of Health of Taiwan, Veterans General Hospital,
and Chang Gung Nemorial Hospital are requesting CDC expertise
and knowledge to assess the risk of nosocomial M.tuberculosis
transmission. The objective of the cooperative activities is
to strengthen tuberculosis infection control activities on Ta-
iwan. Reference reagents may be provide8. All activities are
The annual Implementation Plan will not be distributed to oth-
er parties until it has been approved in final form by AIT and
its designated representative, the CDC, and TECRO, and its de-
signated representative, DOH.
This Implementing Anangement is effective on the date of the
last signature hereafter.
F.AIMENDMENT AND TERMINATION
This Implementing Arrangement may be amended or terminated in
accordance with the tenns of the Guidelines,
IN WITNESS WHEREOF, the undersigned, being duly authorized have
signed this Implementing Arrangement.
DONE at Washington, D.C., in duplicate, in English language.
FOR THE AMERICAN INSTITUTE FOR TALPEI ECONOMIC AND
IN TAIWAN CULTURAL REPRESENTATIVE OFFICE IN
THE UNTTED STATES
Barbara J. Schrage Benjamin J. Y. Lo
Deputy Managing Director Deputy Representative
Date 6/2/99 Date 12/03/99