Prevalence and predictors of compliance with discontinuation of airborne isolation in patients with suspected pulmonary tuberculosis (original) (raw)
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International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases, 2017
The study review guidelines on isolation of patients with tuberculosis, TB, from the World Health Organization, WHO, Centers for Disease Control and Prevention, CDC, and the European Center for Disease Control, ECDC. The review found that unequivocal guidelines for removing patients out of negative-pressure isolation and de-isolation patients from either single rooms or isolation at home is needed. Studies show that the time of effective treatment is the key parameter to follow to determine if patients are contagious to others or not. This means that standard treatment of multi-drug resistant, MDR, TB will not result in the patient being non-infectious. Thus it is important right from the time of diagnosis to know if the patient is infected with MDR TB or not. Thus the early use of molecular techniques to reveal drug susceptibility is important. Clear guidelines stating if patient with microscopy negative sputum no matter infected with fully susceptible or MDR TB, no matter HIV posi...
Open Forum Infectious Diseases
Setting Five health care systems in Texas. Objective To describe the epidemiology of inadequate isolation for pulmonary tuberculosis leading to tuberculosis (TB) exposures from confirmed TB patients and the patient factors that led to the exposures. Design A retrospective cohort and case-control study of adult patients with TB resulting in exposures (cases) vs those TB patients who did not result in exposures (controls) during January 2005 to December 2012. Results There were 335 patients with pulmonary TB disease, 199 cases and 136 controls. There was no difference between groups in age (46 ± 14.6 vs 45 ± 17 years; P > .05), race, or substance abuse. Cases were more likely to be transplant recipients (adjusted odds ratio [AOR], 18.90; 95% CI, 1.9–187.76), have typical TB chest radiograph (AOR, 2.23; 95% CI, 1.1–4.51), and have positive acid-fast bacilli stains (AOR, 2.36; 95% CI, 1.31–4.27). Cases were less likely to have extrapulmonary disease (AOR, 0.47; 95% CI, 0.24–0.95). Co...
Decreasing time spent in airborne infection isolation during TB testing
The International Journal of Tuberculosis and Lung Disease : the official journal of the International Union against Tuberculosis and Lung Disease, 2021
Dear Editor, The COVID-19 pandemic has increased the need to free-up hospital rooms. We have conducted a quasiexperimental retrospective study of an intervention to decrease time in airborne infection isolation (AII) rooms while waiting for tests for TB. 1 The collection and processing of multiple sputum specimens (as recommended by the Centers for Disease Control and Prevention) 2 is a complex endeavor requiring the patient's cooperation and coordination of various health professionals, with frequent delays. Dedicated measures can improve AII efficiency, thereby leading to better infection control, patient flow, savings in healthcare expenditure and psychological impact on patients. 3-5 Moreover, standardized order sets permit uniform, efficient, protocolized care across hospital systems. 6 Boston Medical Center (BMC) is an urban 514-bed academic medical center catering to a diverse patient population. In 2016-2017, approximately 16% of Massachusetts' 400 cases of active TB were diagnosed at BMC (written personal communication, with consent, K M Gadani Massachusetts Department of Public Health, Boston, MA, USA, January 2020). BMC policy for discontinuation of AII stipulates three negative acid-fast bacilli stains or two negative nucleic-acid amplification (NAAT) tests (i.e., Xpert w MTB/RIF assay, Cepheid, Sunnyvale, CA, USA). 7 However, because many patients remain in AII for the collection of a third sputum sample for culture, NAAT results were not included in our definition of time in AII (see below). Providers order the collection or induction of sputum specimens for mycobacterial microscopy/ culture and NAATs electronically, either by placing individual orders, or by utilizing an order set. In the autumn of 2016, a multidisciplinary panel including infectious disease physicians, respiratory therapists (RTs), and nurses assisted information technology specialists in devising a new order set in Epic TM (Epic Systems Corporation; Verona, WI, USA) the electronic medical record (EMR), to decrease time in AII. Orders were streamlined to incorporate NAAT testing on the same specimens sent for culture. Options were created for expectorated sputum every 8 h and sputum inductions twice daily, including one first-morning collection, and timed according to RT staffing, nursing and laboratory workflows, and
Archives of Internal Medicine, 2005
Background: Current guidelines for the control of nosocomial transmission of tuberculosis (TB) recommend respiratory isolation for all patients with suspected TB. Application of these guidelines has resulted in many patients without TB being isolated on admission to the hospital, significantly increasing hospital costs. This study was conducted to prospectively validate a clinical decision rule to predict the need for respiratory isolation in inpatients with suspected TB.
Respiratory Isolation of Patients with Suspected Pulmonary Tuberculosis in an Inner-city Hospital
Academic Emergency Medicine, 1997
Objective: To identify clinical factors that predict which patients presenting to the ED with pneumonia will require respiratory isolation for suspected tuberculosis and to evaluate a protocol for rapid identification of patients at risk for pulmonary tuberculosis (PTB).Methods: To identify potential clinical indicators of PTB, a case-control study was performed using patients admitted to an urban teaching hospital with the ED diagnosis of pneumonia (derivation sample). These predictors were then evaluated in a separate prospective observational study of 103 patients admitted to the same institution from July 1994 to February 1995. Adult patients with the admitting diagnosis of pneumonia were admitted to a respiratory isolation bed if they met 1 of the following criteria: 1) HIV-positive or unknown HIV status with a history of injection drug use; 2) chest x-ray consistent with PTB; or 3) pneumonia with 1 of the following: PPD conversion within 2 years, recent exposure to PTB, previous PTB, or hemoptysis. Patients who did not meet isolation criteria were admitted to the medical ward and had a PPD and anergy panel placed. Those who were anergic or PPD-positive were transferred to respiratory isolation. Results: Predictor variables identified during the first study phase were incorporated into the isolation guidelines noted above. Only 36 of 50 (72%) PTB patients were admitted to an isolation bed during this phase. During the second phase, 103 patients were admitted with the ED diagnosis of pneumonia-rule out PTB; 22 patients (22%) were culture-confirmed positive for PTB. The guidelines predicted PTB as follows: sensitivity, 0.96 (95% CI, 0.88–1.0); specificity, 0.14 (95% CI, 0.08–0.24); positive predictive value, 0.23 (95% CI, 0.17–0.35); and negative predictive value, 0.92 (95% CI, 0.77–1.0). The 1 patient who was not isolated was found to be anergic after 48 hours and subsequently isolated.Conclusion: Respiratory isolation guidelines for patients admitted from the ED with pneumonia were developed and validated. These guidelines provide satisfactory guidance for isolation of patients at risk for PTB in a high-PTB-prevalence population.
Infection Control & Hospital Epidemiology, 2020
Objective:Tuberculosis (TB) transmission in healthcare facilities is still a concern in low-income countries, where airborne isolation rooms are scarce due to high costs. We evaluated the use of single GeneXpert MTB/RIF, the molecular Mycobacterium tuberculosis (MTB) DNA and resistance to rifampicin (RIF) test, as an accurate and faster alternative to the current criteria of 3 negative acid-fast bacilli (AFB) smears to remove patients from airborne isolation.Methods:In this real-world investigation, we evaluated the impact of a single GeneXpert MTB/RIF on the decision making for discharging patients from respiratory isolation. We enrolled patients with suspected pulmonary TB in a public hospital that provides care for high-complexity patients in Brazil. We studied the performance, costs, and time saved comparing the GeneXpert MTB/RIF with AFB smears.Results:We enrolled 644 patients in 3 groups based on the number of AFB smears performed (1, 2, and 3, respectively) on respiratory spe...
Tuberculosis control in New York City hospitals
American Journal of Infection Control, 1998
Objectives: To assess the implementation of tuberculosis (TB) control measures in New York City hospitals in 1992 and determine trends during the subsequent 2 years. Methods: The 22 acute care facilities with the largest number of hospitalized TB patients in 1991 were selected for inclusion in the study. Medical and laboratory records of the 10 most recent acid fast bacilli (AFB) smear-positive patients in each of the selected facilities in 1992, 1993, and 1994 were reviewed by using a standardized questionnaire to determine risk factors for TB, previous history of TB, clinical signs and symptoms, AFB laboratory turnaround times, emergency department contact, timing of isolation, timing of treatment, case reporting, and status on discharge. The patients' rooms were evaluated for TB environmental control measures if the patient was still on respiratory isolation precautions. Results: More than one third of patients were admitted with a previous history of TB, 31% were admitted with a cavitary lesion on chest x-ray examination, and 48% were known to have HIV infection. Eighty-five percent were admitted from the emergency department where they stayed for up to 116 hours (mean stay: 17 hours). The proportion of patients placed in AFB isolation on admission to the tloor increased from 75% in 1992 to 84% in 1994. The proportion of patients given a minimum of four anti-TB drugs increased from 88% in 1992 to 94% in 1994. Patients "on isolation" were sharing rooms with up to nine other patients in 1992, whereas no patients were sharing rooms in the 1994 survey. In 1992, 51% of the rooms were under negative air flow with respect to the corridor. During the 1994 survey, 80% of rooms were under negative air flow. Between 1992 and 1994, the proportion of AFB isolation rooms with dust/mist respirators increased from 28% to 76% (p < 0.00001). Approximately 25% of discharged patients left against medical advice (no trend over time). The proportion of medically discharged patients with three negative AFB smears before discharge increased from 26% to 48% (p = 0.03) and the proportion referred for directly observed therapy increased from 15% to 53% (p ---0.00001). Conclusion: TB control efforts in New York City hospitals improved dramatically between 1992 and 1994. The ultimate control of TB will continue to depend on the coordinated efforts within and between health care facilities, providers, and the community. (AJIC Am J Infect Control 1998;26:270-6.)
JAMA internal medicine, 2018
New guidelines recommend that molecular testing replace sputum-smear microscopy to guide discontinuation of respiratory isolation in patients undergoing evaluation for active tuberculosis (TB) in health care settings. To evaluate the implementation and impact of a molecular testing strategy to guide discontinuation of isolation. Prospective cohort study with a pragmatic, before-and-after-implementation design of 621 consecutive patients hospitalized at Zuckerberg San Francisco General Hospital and Trauma Center who were undergoing sputum examination for evaluation for active pulmonary TB from January 2014 to January 2016. Implementation of a sputum molecular testing algorithm using GeneXpert MTB/RIF (Xpert; Cepheid) to guide discontinuation of isolation. We measured the proportion of patients with molecular testing ordered and completed; the accuracy of the molecular testing algorithm in reference to mycobacterial culture; the duration of each component of the testing and isolation ...