Objectives Provision of medical surveillance for staff in health facilities with large numbers of TB and HIV positive patients is important. South African legislation also requires medical surveillance to be conducted in all hospitals.

Methods Staff in the medical wards of a large public hospital in Johannesburg were invited to participate in the survey covering TB symptoms and attitudes towards regular surveillance. A walk through audit was also conducted in the wards to evaluate TB controls.

Results Of the 200 staff available to participate 44% returned questionnaires with doctors and consultants noticeably missing. TB exposure was found in all wards with an average of 10% of patients diagnosed with TB; despite this 30% of staff felt they were not exposed. Further investigations were recomended for 9% of staff who indicated TB symptoms were present, of those followed up 11% were diagnosed with TB. This gives a 2.3% prevalence of TB in the medical wards of the hospital. 85% of staff were in favour of routine medical surveillance and 48% were willing to disclose HIV status if early treatment were provided.

Conclusions A symptom questionnaire can help identify those requiring investigation for TB. This is a cost effective means of conducting regular medical surveillance in a medical facility. For a medical surveillance program to be successful there needs a dedicated occupational health staff to run the program to involve doctors in the process and to conduct training on health risks.