A retrospective review of a tertiary Hospital’s isolation and de-isolation policy for suspected pulmonary tuberculosis

BMC Infectious Diseases

Jenny GH Low²  Ban Hock Tan²  Jeanne MM Tan¹  Shirin Kalimuddin² 

[1] Department of Internal Medicine, Singapore General Hospital, 20 College Road, Singapore 169856, Singapore;Department of Infectious Diseases, Singapore General Hospital, 20 College Road, Singapore 169856, Singapore

关键词: Isolation;    AFB smear;    Tuberculosis;   

Others  :  1125419
DOI  :  10.1186/s12879-014-0547-7

 received in 2013-06-24, accepted in 2014-10-07,  发布年份 2014

【 摘 要 】

Background

Effective protocols for the isolation and de-isolation of patients with suspected pulmonary tuberculosis (PTB) are essential determinants of health-care costs. Early de-isolation needs to be balanced with the need to prevent nosocomial transmission of PTB. The aim of our study was to evaluate the efficiency of our hospital’s current protocol for isolating and de-isolating patients with suspected PTB, in particular assessing the timeliness to de-isolation of patients with AFB smear negative respiratory samples.

Methods

We retrospectively reviewed 121 patients with suspected PTB who were admitted to our hospital’s isolation ward. We analyzed the time spent in isolation, the total number of respiratory samples that were collected for each patient and the time taken from collection of the first respiratory sample to release of the result of third respiratory sample for acid-fast bacilli (AFB) smear. We also calculated the direct cost of isolation for each patient.

Results

The mean and median number of AFB smears for each patient was three. Thirty percent of patients had four or more AFB smears taken and 20% were de-isolated before the results of three negative AFB smears were obtained. The mean duration of isolation was significantly shorter in patients who had fewer than three negative AFB smears compared to those who had three or more negative AFB smears (three days vs. five days, p <0.01). The mean cost in patients who were de-isolated before three negative smears were obtained was USD 947 compared to USD 1,636 in those were only de-isolated after three negative AFB smears (p <0.01).

Conclusions

Our study suggests that our institution’s current infection control policy for the isolation of patients with suspected PTB is fairly satisfactory, but may need to be tightened further to prevent true cases of PTB being de-isolated prematurely. However, there may be instances when patients could potentially be de-isolated more quickly without risk to others, thus saving on the use of limited resources and costs to patients.

【 授权许可】

   
2014 Kalimuddin et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1][http://www.who.int/tb/publications/global_report/en/] webcite World Health Organization: Global tuberculosis control. 2012, [].
• [2][http://www.who.int/tb/country/data/profiles/en] webcite World Health Organization: Tuberculosis country profiles: Singapore. 2012, [].
• [3]Cutter J, Wang YT: Tuberculosis – an underappreciated disease. Ann Acad Med 2010, 39:261-262.
• [4]LoBue PA, Catanzaro A: Effectiveness of a nosocomial tuberculosis control program at an urban teaching hospital. Chest 1998, 113:1184-1189.
• [5]Sepkowitz KA: How contagious is tuberculosis? Clin Infect Dis 1996, 23:954-962.
• [6]Kelly-Rossini L, Perlman DC, Mason DJ: The experience of respiratory isolation for HIV-infected persons with tuberculosis. J Assoc Nurses AIDS Care 1996, 7:29-36.
• [7]Wilmer A, Bryce E, Grant J: The role of third acid-fast bacillus smear in tuberculosis screening for infection control purposes: a controversial topic revisited. Can J Infect Dis Med Microbiol 2011, 22(1):e1-e3.
• [8]Guidelines for preventing the transmission of mycobacterium tuberculosis in health-care settings, 2005 MMWR 2005, 54(RR-17):1-141.
• [9]Bass JB, Farer LS, Hopewell PC, Jacobs RF, Snider DE: Diagnostic standards and classification of tuberculosis. Ann Rev Respir Dis 1990, 149:1359-1374.
• [10]Nelson SM, Deike MA, Cartwright CP: Value of examining multiple sputum specimens in the diagnosis of pulmonary tuberculosis. J Clin Microbiol 1998, 36:467-469.
• [11]Siddiqui AH, Perl TM, Conlon M, Donegan N, Roghmann M: Preventing nosocomial transmission of pulmonary tuberculosis: when may isolation be discontinued for patients with suspected tuberculosis? Infect Control Hosp Epidemiol 2002, 23:141-144.
• [12]Burken MI, Shea JA, Johnson CC, Hershey JC, Asch DA: Comparison of sputum microscopy versus nucleic acid amplification for the presumptive diagnosis of pulmonary tuberculosis: a meta-analysis. Clin Performance Qual Health Care 1998, 6:53-59.
• [13]Wisnivesky JP, Henschke C, Balentine J, Wilner C, Delorie A, McGinn T: Prospective validation of a prediction rule to assess the need for respiratory isolation for inpatients with suspected tuberculosis. Arch Intern Med 2005, 165:453-457.
• [14]Wisnivesky JP, Kaplan J, Henschke C, McGinn T, Crystal RG: Evaluation of clinical parameters to predict Mycobacterium tuberculosis in inpatients. Arch Inter Med 2000, 160:2471-2476.
• [15]Tattevin P, Casalino E, Fleury L, Egmann G, Ruel M, Bouvet E: The validity of medical history, classic symptoms, and chest radiographs in predicting pulmonary tuberculosis: derivation of a pulmonary tuberculosis prediction model. Chest 1999, 115:1248-1253.
• [16]Wisnivesky JP, Serebrisky D, Moore C, Sacks H, Iannuzzi MC, McGinn T: Validity of clinical prediction rules for isolating in patients with suspected tuberculosis – a systematic review. J Gen Int Med 2005, 20:947-952.
• [17]Li LM, Bai LQ, Yang HL, Xiao CF, Tang RY, Chen YF, Chen SM, Liu SS, Zhang SN, Ou YH, Niu TI: Sputum induction to improve the diagnostic yield in patients with suspected pulmonary tuberculosis. Int J Tuberc Lung Dis 1999, 3:1137-1139.
• [18]Al Zahrani K, Al Jahdali H, Poirier L, René P, Menzies D: Yield of smear, culture and amplification tests from repeated sputum induction for the diagnosis of pulmonary tuberculosis. Int J Tuberc Lung Dis 2001, 5:855-860.