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Zhang C, O’Connor S, Smith-Jeffcoat SE, Rodriguez DF, Guo H, Hao L, Chen H, Sun Y, Li Y, Xu J, Chen L, Xia L, Yang X, Date A, Cheng J. Implementing a continuous quality-improvement framework for tuberculosis infection prevention and control in healthcare facilities in China, 2017-2019. Infect Control Hosp Epidemiol 2024; 45:651-657. [PMID: 38268435 PMCID: PMC11027078 DOI: 10.1017/ice.2023.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/28/2023] [Accepted: 12/01/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Tuberculosis (TB) infection prevention and control (IPC) in healthcare facilities is key to reducing transmission risk. A framework for systematically improving TB IPC through training and mentorship was implemented in 9 healthcare facilities in China from 2017 to 2019. METHODS Facilities conducted standardized TB IPC assessments at baseline and quarterly thereafter for 18 months. Facility-based performance was assessed using quantifiable indicators for IPC core components and administrative, environmental, and respiratory protection controls, and as a composite of all control types We calculated the percentage changes in scores over time and differences by IPC control type and facility characteristics. RESULTS Scores for IPC core components increased by 72% during follow-up when averaged across facilities. The percentage changes for administrative, environmental, and respiratory protection controls were 39%, 46%, and 30%, respectively. Composite scores were 45% higher after the intervention. Overall, scores increased most during the first 6 months. There was no association between IPC implementation and provincial economic development or volume of TB services. CONCLUSIONS TB IPC policies and practices showed most improvement early during implementation and did not differ consistently by facility characteristics. The training component of the project helped increase the capacity of healthcare professionals to manage TB transmission risks. Lessons learned here will inform national TB IPC guidance.
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Affiliation(s)
- Canyou Zhang
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Stephanie O’Connor
- Global Health Center, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Sarah E. Smith-Jeffcoat
- Global Health Center, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Diana Forno Rodriguez
- Global Health Center, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Hui Guo
- CSL Behring Beijing Office, Beijing, China
| | - Ling Hao
- US Centers for Disease Control and Prevention China Office, Beijing, China
| | - Hui Chen
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yanbo Sun
- Heilongjiang Provincial Center for Disease Control and Prevention, Harbin, Heilongjiang, China
| | - Yan Li
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Jiying Xu
- Henan Provincial Center for Disease Control and Prevention, Zhengzhou, Henan, China
| | - Liang Chen
- Guangdong Provincial Institute of Public Health, Guangzhou, Guangdong, China
| | - Lan Xia
- Sichuan Provincial Center for Disease Control and Prevention, Chengdu, Sichuan, China
| | - Xing Yang
- Yunnan Provincial Center for Disease Control and Prevention, Kunming, Yunnan, China
| | - Anand Date
- Global Health Center, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Jun Cheng
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Guan CP, Wu YH, Wang XF, He Y, Zhang YA, Wang MS. The performance of interferon gamma release assays in patients with nontuberculous mycobacterial infection: a systematic review and meta-analysis. Eur J Clin Microbiol Infect Dis 2023; 42:1251-1262. [PMID: 37702955 DOI: 10.1007/s10096-023-04662-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 09/06/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND The actual positive rate of interferon gamma release assays (IGRAs) in patients with nontuberculous mycobacteria (NTM) infections remains unclear. This review and meta-analysis present the prevalence of positive IGRAs (T-SPOT.TB and QuantiFERON [QFT] tests) among patients infected with NTM isolates (with or without ESAT-6/CFP-10). METHODS Several databases, including PubMed, Scopus, Embase, and Web of Science were searched (until June 18th, 2022). Studies that had the following data were included: (1) results of T-SPOT.TB, QuantiFERON (QFT) test, or both, (2) NTM species, and (3) NTM diseases, or NTM colonization. The metaprop command that incorporates a Freeman-Tukey double arcsine transformation is used for pooling proportions. RESULTS A total of 11 articles (n = 929) were deemed eligible for inclusion. Meta-analysis identified that the overall pooled positive and indeterminate rates of IGRA results in patients with NTM infections was 16% and 5%, respectively. Subgroup analysis showed that the positive rate of IGRAs in patients infected with NTM (without ESAT-6/CFP-10) was 7% (95% CI, 1%-18%), and 44% (95%CI, 22%-68%) in patients infected with NTM (with ESAT-6/CFP-10). In addition, the indeterminate rate of QFT (7%, 95% CI: 4%-12%) was higher than that of T-SPOT.TB (0%; 95% CI, 0%-2%) among the overall population with NTM infections. CONCLUSIONS The IGRAs have a moderate positive rate for the diagnosis of NTM (expressing ESAT-6/CFP-10) infections, and a significant indeterminate rate is observed among the overall population infected with NTM. However, these findings should be interpreted with caution because of the high heterogeneity among studies.
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Affiliation(s)
- Cui-Ping Guan
- Department of Lab Medicine, Shandong Public Health Clinical Center, Shandong University, Jinan, 250013, China
| | - Yan-Hua Wu
- Department of Lab Medicine, Shandong Public Health Clinical Center, Shandong University, Jinan, 250013, China
| | - Xin-Feng Wang
- Department of Lab Medicine, Shandong Public Health Clinical Center, Shandong University, Jinan, 250013, China
| | - Yu He
- Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, 530012, China
| | - Yan-An Zhang
- Department of Cardiovascular Surgery, Shandong Public Health Clinical Center, Shandong University, Jinan, 250013, China
- Shandong Key Laboratory of Infectious Respiratory Disease, Jinan, 250013, China
| | - Mao-Shui Wang
- Department of Lab Medicine, Shandong Public Health Clinical Center, Shandong University, Jinan, 250013, China.
- Shandong Key Laboratory of Infectious Respiratory Disease, Jinan, 250013, China.
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Guo HY, Zhong QH, Zhou J, Zhao ZM, Zhang XL, Chen ZH, Qiu XC, Wu ZL. Risk of prevalence of latent tuberculosis infection in health care workers-an idiographic meta-analysis from a Chinese perspective. J Thorac Dis 2021; 13:2378-2392. [PMID: 34012586 PMCID: PMC8107561 DOI: 10.21037/jtd-20-1612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background China is one of the countries sharing the major burden of tuberculosis (TB) in the world. Health care workers (HCWs) are subject to a high risk of occupational latent tuberculosis infection (LTBI)-an asymptomatic state of TB disease. However, the heterogenic composition of healthcare professionals in terms of nature of their work leads to the inconsistency in predicting the prevalence of LTBI amongst them. Furthermore, the global statistics do not account for the analysis conducted within the Chinese population. Our study reflects a systemic and epidemiological meta-analysis to investigate the risk of contracting LTBI by the HCWs of China. Methods A systematic review of the literature was performed to identify studies reporting LTBI prevalence or incidence among HCWs and a control groups in China. Risk of infection, as well as subgroup analysis was calculated by pooled effect estimates. Review Manager 5.0 was used to perform the meta-analyses. Results Twenty studies containing 9,654 HCWs met the inclusion criteria. The average prevalence of LTBI among HCWs was 51.5%, ranging from 27.9-88.8%. HCWs had a higher risk of prevalence of LTBI than the control groups [odds ratio (OR), 1.78, 95% confidence interval (CI), 1.46-2.16]. In the subgroup analysis, the prevalence of LTBI in HCWs with respect to the control groups was observed to be highest in Eastern China (OR, 2.05; 95% CI, 1.35-3.11). Furthermore, the pooled OR for LTBI was 1.90 and 1.65 separately from the results of the tuberculin skin test (TST) and the interferon-gamma release assay. Lastly, upon comparing the HCWs with the control groups from the community and the nosocomial source, it was observed that the pooled OR favored for the prevalence of LTBI, which was primarily community-sourced (3.12 and 1.54). HCWs had an increased risk of prevalence of LTBI than the control groups, both in general hospitals and TB specific hospitals (pooled OR 2.4 and 1.57). Conclusions Risk of LTBI infection among HCWs is relatively high in China, especially in the eastern region, predisposed by the cumulative exposure to Mycobacterium tuberculosis from the community and the general hospitals. Overall, our data reflects an alarming risk posed to our HCWs, and calls for immediate reforms at the policy levels, so as to implement effective screening and treatment of affected HCWs in China.
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Affiliation(s)
- Hai-Yan Guo
- Department of Respiratory Medicine, Nanhai Hospital Affiliated to Southern Medical University, Foshan, China
| | - Qian-Hong Zhong
- Department of Respiratory Medicine, The Fourth People's Hospital of Foshan (Tuberculosis Control Center of Foshan), Foshan, China
| | - Jie Zhou
- Department of Respiratory Medicine, Foshan Hospital of TCM, Foshan, China
| | - Zhi-Meng Zhao
- Department of Respiratory Medicine, The Fourth People's Hospital of Foshan (Tuberculosis Control Center of Foshan), Foshan, China
| | - Xi-Lin Zhang
- Department of Respiratory Medicine, The Fourth People's Hospital of Foshan (Tuberculosis Control Center of Foshan), Foshan, China
| | - Zhen-Huang Chen
- Department of Respiratory Medicine, Nanhai Hospital Affiliated to Southern Medical University, Foshan, China.,The Second School of Clinical Medicine, Southern Medical University, Foshan, China
| | - Xin-Cai Qiu
- Department of Respiratory Medicine, Nanhai Hospital Affiliated to Southern Medical University, Foshan, China.,The Second School of Clinical Medicine, Southern Medical University, Foshan, China
| | - Zhi-Long Wu
- Department of Respiratory Medicine, The Fourth People's Hospital of Foshan (Tuberculosis Control Center of Foshan), Foshan, China
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Wardani HR, Mertaniasih NM, Soedarsono S. RISK FACTORS OF LATENT TUBERCULOSIS INFECTION IN HEALTHCARE WORKERS AT HOSPITALS IN JEMBER CITY INDONESIA. Afr J Infect Dis 2020; 15:34-40. [PMID: 33884356 PMCID: PMC8047285 DOI: 10.21010/ajid.v15i1.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 12/24/2022] Open
Abstract
Background: Healthcare workers in Tuberculosis (TB) and non-TB units in hospitals have a high risk of experiencing Latent Tuberculosis Infection (LTBI), because of exposure to droplets containing Mycobacterium tuberculosis. This study aims to prove LTBI incidence and risk factors to healthcare workers at the hospital in Jember City. Material and Methods: a cross-sectional study, from January to March 2020 in two hospitals in Jember City. Healthcare workers in the TB care and non-TB care unit were examined using Tuberculin skin test (TST) with a cut off ≥ 10 mm for positive LTBI. Chest x-ray and clinical examination to rule out active TB and a standardized questionnaire were also used. Results: 128 healthcare workers completed the questionnaires, clinical, tuberculin skin test (TST), and chest x-ray data. LTBI incidence of positive results 61.7% (n = 79). Contacts TB in the workplace (p value = 0.219; OR = 1.643; CI = 0.742-3.641) and a unit of work (p value = 0.102; OR = 0.760; CI = 0.559-1.031) has no relationship with LTBI. The profession (p value = 0.020; OR = 1.112; CI = 0.896-1.403), the duration of the work (p value = 0.039; OR = 2.984; CI = 1.067-8.342), and BCG immunization (p value =0.000; OR = 0.151; CI = 0.052-0.438) have important relationships with LTBI. Conclusion: TB infection with a high incidence, a risk of transmission to healthcare workers, and a relationship between occupational risk factors and LTBI among healthcare workers in Jember City, Indonesia have been established in this study.
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Affiliation(s)
- Hamidah Retno Wardani
- Student of Master Program of Tropical Medicine, Faculty of Medicine, Universitas Airlangga, Jl. Mayjen. Prof. Dr. Moestopo No. 47, Surabaya 60131, Indonesia
| | - Ni Made Mertaniasih
- Department of Clinical Microbiology, Faculty of Medicine, Universitas Airlangga, Jl. Mayjen. Prof. Dr. Moestopo No. 47, Surabaya 60131, Indonesia
| | - Soedarsono Soedarsono
- Department of Pulmonology, Faculty of Medicine, Universitas Airlangga-Dr. Soetomo Hospital, Jl. Mayjen. Prof. Dr. Moestopo No. 47, Surabaya 60131, Indonesia
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