1000 Tuberculosis risk assessment in hospital settings

Abstract

Introduction Tuberculosis (TB) is an occupational hazard for healthcare workers. National and internationals policies establish occupational TB risk assessment through the number of patients with TB per year for the whole facility. However, in an hospital setting with different workplaces, it's important to independently classify TB risk in every work environment in order to implement cost-effective preventive measures. Methods We establish a TB risk matrix for our 500-beds hospital and we applied it retrospectively to each department from 2014 to 2016. We studied the following variables: frequency (number of inpatients with infectious TB per service per year), exposure (period of time without isolation measures per patient or, in case of outpatient setting, performance of high-risk procedures for transmission) and severity of the occupational disease.Results The highest risk of occupational TB was found through the studied years in Emergency, Pneumology and Infectiology Departments. However, there was a decrease in the last year due to better isolation measures. Internal Medicine and Otorhinolaryngology wards were considered very high-risk departments due to prolonged exposure to TB patients without any control procedures. Imageology and Primary Care ward were consistently classified as high-risk as result of the high number of TB patients assisted. Exceptionally, in 2015, Intensive Care and Stroke units as well as Psychiatry department were found to have very high-risk TB infection due to a prolonged admission of one patient without isolation procedures. The other departments were classified as moderate or low risk. Discussion All healthcare institutions should conduct TB risk assessment periodically as risk classification may change. These results allow to identify which departments have high-risk of occupational TB infection, in order to undertake specific preventive strategies and TB screening accordingl.