In-hospital contact investigation among health care workers after exposure to pulmonary tuberculosis in an intermediate tuberculosis prevalence area: A prospective study

Predictive Factors and Clinical Impacts of Delayed Isolation of Tuberculosis during Hospital Admission

Delayed isolation of tuberculosis (TB) can cause unexpected exposure of healthcare workers (HCWs). This study identified the predictive factors and clinical impact of delayed isolation. We retrospectively reviewed the electronic medical records of index patients and HCWs who underwent contact investigation after TB exposure during hospitalization at the National Medical Center, between January 2018 and July 2021. Among the 25 index patients, 23 (92.0%) were diagnosed with TB based on the molecular assay, and 18 (72.0%) had a negative acid-fast bacilli smear. Sixteen (64.0%) patients were hospitalized via the emergency room, and 18 (72.0%) were admitted to a non-pulmonology/infectious disease department. According to the patterns of delayed isolation, patients were classified into five categories. Among 157 close-contact events in 125 HCWs, 75 (47.8%) occurred in Category A. Twenty-five (20%) HCWs had multiple TB exposures (n = 57 events), of whom 37 (64.9%) belonged to Category A (missed during emergency situations). After contact tracing, latent TB infection was diagnosed in one (1.2%) HCW in Category A, who was exposed during intubation. Delayed isolation and TB exposure mostly occurred during pre-admission in emergency situations. Effective TB screening and infection control are necessary to protect HCWs, especially those who routinely contact new patients in high-risk departments.

Tuberculosis infection status and risk factors among health workers: an updated systematic review

Tuberculosis (TB) infection is a common occupational risk for health workers (HWs) and poses a threat to the patients under their care and to other HWs. Hence, the development of a prevention strategy is crucial. We conducted a study to understand the status and risk factors of TB infection among HWs. The existing literature was searched for all published reports from 1 August 2010 to 31 December 2018, related to TB among HWs according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The inclusion criteria were: (1) study participants working in a health care facility; (2) TB cases diagnosed by medical professionals; (3) original research articles; and (4) English reports in a peer-reviewed journal. We finally included 61 studies from 642 articles searched initially. The TB infection rate in HWs was higher than that of the general population. Based on 39 studies, the prevalence of TB in HWs (tuberculin skin test positive) was 29.94%. In contrast, the global burden of latent TB infection was 23.0% (95% uncertainty interval: 20.4%–26.4%) in 2014. The risk factors of TB among HWs were aging, long duration of employment, nursing professionals, lack of Bacillus Calmette-Guerin vaccination, and low body mass index. HWs have an increased risk for TB infection, which can cause secondary infections in patients or other HWs. An effective prevention strategy must be developed to enable early diagnosis and prompt treatment.

Registered nurses are at increased risk of hospitalization for infectious diseases and perinatal complications: A population-based observational study

Background

Nursing staff spend long periods in high-risk working environments.

Objective

The purpose of this study was to compare the hospitalization risk between nursing staff and the general population.

Design

This study adopted a retrospective observational design.

Setting

Data from the Taiwan National Health Insurance Research Database from 2011 to 2013 were analyzed.

Method

The standardized hospitalization ratio model was used to analyze the relative risk of hospitalization for various diseases between nursing staff and the general population.

Results

A total of 33,267 numbers of nursing staff in Taiwan were hospitalized, an overall crude hospitalization rate of 21.5%. After controlling for gender, calendar year, and age of nursing staff, the standardized hospitalization ratio of female nursing staff was significantly higher compared to the general population for infectious and parasitic diseases (SHR = 121.05, 95% CI = 112.66–129.89), diseases of the respiratory system (SHR = 105.12, 95% CI = 100.60–109.80), complications of pregnancy, childbirth, and the puerperium (SHR = 102.59, 95% CI = 100.85–104.35), and diseases of the skin and subcutaneous tissue (SHR = 109.71, 95% CI = 101.10–118.86).

Conclusions

Nursing staff have a significantly higher hospitalization risk compared to the general population for infectious and parasitic diseases, diseases of the respiratory system, complications of pregnancy, childbirth, and puerperium, and diseases of the skin and subcutaneous tissue. This may be associated with the job characteristics and environment of nursing staff.

Predictors for false-negative QuantiFERON-TB Gold assay results in patients with extrapulmonary tuberculosis

BACKGROUNDS

Extrapulmonary tuberculosis (EPTB) is a heterogeneous disease, and diagnosis is sometimes difficult. We investigated the diagnostic performance of the QuantiFERON-TB Gold assay (QFT-GIT) according to sites of EPTB and predictors for false-negative QFT-GIT results.

METHODS

A total of 2176 patients were registered with active TB from January 2012 to December 2016 in Seoul St. Mary's Hospital, a 1200-bed tertiary teaching hospital in Seoul, Korea. We retrospectively reviewed the medical records of 163 EPTB patients who underwent QFT-GIT.

RESULTS

False negative QFT-GIT results were found in 28.8% (95% CI 0.22-0.36) of patients with EPTB. In the proven TB group, negative QFT-GIT results were found in 28.6% (95% CI 0.04-0.71) of pleural, 8.3% 0.002-0.38of lymph node, 8.3% (95% CI 0.002-0.38) of skeletal and 5.8% (95% CI 0.001-0.28) of gastrointestinal TB cases. Among probable TB cases, QFT-GIT negative results were identified in 46.2% (95% CI 0.19-0.75) of skeletal, 33.3% (95% CI 10-0.65) of pericardial, 30.8% (95% CI 0.09-0.61) of pleural and 17.2% (95% CI 0.10-0.56) of gastrointestinal TB cases. In the possible TB cases, central nervous system TB (n = 21) was most frequent, and 66.7% (95% CI 0.43-0.85) of those showed QFT-GIT negative results. By multivariate analysis, possible TB was independently associated with false-negative QFT-GIT results (OR 4.92, 95% CI 1.51-16.06, p = 0.008).

CONCLUSIONS

Prudent interpretation of QFT-GIT results might be needed according to anatomic site of involvement and diagnostic criteria in patients with high suspicion of EPTB.

Tuberculosis contact investigation in an intermediate burden setting: implications from a large tuberculosis contact cohort in Taiwan

There are still several unanswered research questions regarding tuberculosis (TB) contact investigations [1–4]. For example, up-to-date epidemiological studies regarding TB contacts in the area of intermediate incidence are not readily available [5]. The long-term risk of TB, especially beyond 5 years, remains undetermined [6]. Risk factors for TB development among contacts are also not well defined [2]. To expand current understanding and knowledge of TB contact investigation, we recruited a population-based TB contacts cohort utilising the National Health Insurance Research Database of Taiwan, which included medical care claims data of 99% Taiwan residents [7].

Taiwan TB contact cohort: 0.5% 1-year yield, age ≥65 as significant risk factor and elevated TB risk at 5th year http://ow.ly/9ZGr30dpkMc