Hospital Control and Multidrug-Resistant Pulmonary Tuberculosis in Female Patients, Lima, Peru

Willingham, Field F.; Schmitz, Tracy L.; Contreras, M Schulz; Kalangi, Sheela E.; Vivar, Aldo; Caviedes, Luz; Schiantarelli, Eduardo; Neumann, Paola Maurtua; Bern, Caryn; Gilman, Robert H.

doi:10.3201/eid0701.010117

Cited by 25 publications

(24 citation statements)

References 14 publications

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“…However, it has been well recognized that the risk of TB transmission from unsuspected or unrecognized patients is likely far greater than the risk from known patients with TB, in large part because patients who are not yet diagnosed may more readily emit infectious aerosols than patients under effective treatment (27). Although there have been few comprehensive studies on the exact prevalence of unsuspected TB, a few surveys among general medical wards or emergency departments have revealed that approximately one-third of patients with TB may pass through the early stages of entry into hospital unsuspected (28,29). In high-burden settings with limited existing infection control resources, masks may be a relatively inexpensive yet effective initial measure through which to limit TB transmission, especially if offered and used short term by all patients presenting with prolonged cough or other symptoms suggestive of TB, for example.…”

Section: Discussionmentioning

confidence: 99%

Surgical Face Masks Worn by Patients with Multidrug-Resistant Tuberculosis

Dharmadhikari

Mphahlele

Stoltz

et al. 2012

Am J Respir Crit Care Med

164

130

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Rationale: Drug-resistant tuberculosis transmission in hospitals threatens staff and patient health. Surgical face masks used by patients with tuberculosis (TB) are believed to reduce transmission but have not been rigorously tested. Objectives: We sought to quantify the efficacy of surgical face masks when worn by patients with multidrug-resistant TB (MDR-TB). Methods: Over 3 months, 17 patients with pulmonary MDR-TB occupied an MDR-TB ward in South Africa and wore face masks on alternate days. Ward air was exhausted to two identical chambers, each housing 90 pathogen-free guinea pigs that breathed ward air either when patients wore surgical face masks (intervention group) or when patients did not wear masks (control group). Efficacy was based on differences in guinea pig infections in each chamber. Measurements and Main Results: Sixty-nine of 90 control guinea pigs (76.6%; 95% confidence interval [CI], 68-85%) became infected, compared with 36 of 90 intervention guinea pigs (40%; 95% CI, 31-51%), representing a 56% (95% CI, 33-70.5%) decreased risk of TB transmission when patients used masks. Conclusions: Surgical face masks on patients with MDR-TB significantly reduced transmission and offer an adjunct measure for reducing TB transmission from infectious patients.Keywords: infection control; multidrug-resistant tuberculosis; transmission; surgical maskOf an estimated 9 million new cases of tuberculosis (TB) in 2008 globally (1), 440,000 were multidrug-resistant TB (MDR-TB) (2), and more than half of those are believed to have occurred in previously untreated patients, the result of transmission of already drug-resistant strains (2). Recent reports of infection with highly drug-resistant strains of Mycobacterium tuberculosis among patients and health care workers illustrate the dire consequences of nosocomial transmission, especially in areas where HIV is endemic (3, 4). Although once believed to arise primarily from unsupervised or erratic treatment of drug-susceptible TB, MDR-TB and extensively drug-resistant TB (XDR-TB) are now known to be transmissible and have emerged as important threats to patients who enter hospitals for drug-susceptible TB (reinfection) or other illnesses, to the clinical staff caring for them, and to occupants of other congregate settings, such as correctional facilities and shelters. One study in Russia found that hospitalization, rather than treatment nonadherence, conferred a sixfold greater relative risk for the acquisition of MDR-TB by patients (5), whereas another study in Latvia revealed that previous hospitalization was a highly significant risk factor for MDR-TB (odds ratio, 18.33; P , 0.002) (6). In addition, health care workers in diverse settings have been shown to be disproportionately exposed to and infected with drugsusceptible and drug-resistant TB (4, 7). TB among health care workers erodes the already limited supply of hospital personnel in many resource-constrained settings, both directly through illness and indirectly through fear of working in such high-risk envi...

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Section: Discussionmentioning

confidence: 99%

Surgical Face Masks Worn by Patients with Multidrug-Resistant Tuberculosis

Dharmadhikari

Mphahlele

Stoltz

et al. 2012

Am J Respir Crit Care Med

164

130

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“…461,462 464 Following the widely publicised and high-mortality outbreak of XDR tuberculosis at the Church of Scotland Hospital in KwaZulu-Natal, South Africa, a series of similar targeted interventions have dramatically reduced transmission in the hospital and in the community.…”

Section: Importance Of Unsuspected Drug Resistancementioning

confidence: 99%

The epidemiology, pathogenesis, transmission, diagnosis, and management of multidrug-resistant, extensively drug-resistant, and incurable tuberculosis

Dheda

Gumbo

Maartens

et al. 2017

The Lancet Respiratory Medicine

533

474

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“…Under high-burden conditions, TB is commonly missed in persons presenting with unrelated conditions (Willingham et al 2001;Bates et al 2012Bates et al , 2013. Under low-burden conditions, the diagnosis is less likely to be considered even with classical symptoms.…”

Section: Administrative Approaches To Tb Transmission Control Known Omentioning

confidence: 99%

“…Under low-burden conditions, the diagnosis is less likely to be considered even with classical symptoms. Studies in Peru and Africa have shown the prevalence of unsuspected TB in general medical settings, including smear-positive, drug-resistant cases (Willingham et al 2001;Bates et al 2012). …”

Section: Administrative Approaches To Tb Transmission Control Known Omentioning

confidence: 99%

Transmission and Institutional Infection Control of Tuberculosis

Nardell

2015

Cold Spring Harb Perspect Med

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Tuberculosis (TB) transmission control in institutions is evolving with increased awareness of the rapid impact of treatment on transmission, the importance of the unsuspected, untreated case of transmission, and the advent of rapid molecular diagnostics. With active case finding based on cough surveillance and rapid drug susceptibility testing, in theory, it is possible to be reasonably sure that no patient enters a facility with undiagnosed TB or drug resistance. Droplet nuclei transmission of TB is reviewed with an emphasis on risk factors relevant to control. Among environmental controls, natural ventilation and upper-room ultraviolet germicidal ultraviolet air disinfection are the most cost-effective choices, although high-volume mechanical ventilation can also be used. Room air cleaners are generally not recommended. Maintenance is required for all engineering solutions. Finally, personal protection with fittested respirators is used in many situations where administrative and engineering methods cannot assure protection. HOW TUBERCULOSIS IS TRANSMITTED

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Hospital Control and Multidrug-Resistant Pulmonary Tuberculosis in Female Patients, Lima, Peru

Cited by 25 publications

References 14 publications

Surgical Face Masks Worn by Patients with Multidrug-Resistant Tuberculosis

Surgical Face Masks Worn by Patients with Multidrug-Resistant Tuberculosis

The epidemiology, pathogenesis, transmission, diagnosis, and management of multidrug-resistant, extensively drug-resistant, and incurable tuberculosis

Transmission and Institutional Infection Control of Tuberculosis

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