Hospital Ventilation and Risk for Tuberculous Infection in Canadian Health Care Workers

Menzies, Dick; Fanning, Anne; Liang, Yuan; FitzGerald, J. Mark

doi:10.7326/0003-4819-133-10-200011210-00010

Cited by 179 publications

(166 citation statements)

References 49 publications

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“…Furthermore, through pre-employment screening, contact investigation and periodical screening of HCWs, a number of latent TB infections are identified (250 annually in the Netherlands) and treated in the majority of cases [10]. However, as the present data show, a significant proportion of these infections have been acquired outside the hospital, as has been observed in other studies [19][20][21]. Furthermore, other patients (and visitors) might be at even greater risk if TB is not suspected and diagnosis is delayed.…”

Section: Total Delay In Diagnosis 12contrasting

confidence: 54%

Healthcare workers with tuberculosis infected during work

Vries¹,

Šebek²,

Weezenbeek³

2006

Eur Respir J

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The risk for healthcare workers (HCWs) of tuberculosis (TB) attributable to occupational exposure is difficult to determine, as are the conditions contributing to this risk. The objective of the present study was to determine which TB cases among HCWs in the Netherlands were infected during work and to analyse factors which contributed to infection and subsequent disease.The total study population consisted of 101 cases over a 5-yr period. In 67 (66%) subjects the route of infection could be determined by epidemiological and microbiological information. Of these cases, 28 out of 67 (42%) were due to infection at work, 19 (28%) were community acquired, and 20 (30%) were infected abroad.The 28 cases infected at work were subject to an in-depth analysis. Delayed diagnosis of the index case, especially in the elderly patient, was the main cause of patient-to-HCW transmission. In some circumstances, inadequate infection-control measures also contributed to transmission.In conclusion, a high suspicion of tuberculosis by the clinician, adequate infection control measures by hospital authorities, and early identification of latent tuberculosis infection by occupational and public-health specialists are necessary to prevent tuberculosis among healthcare workers.

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Section: Total Delay In Diagnosis 12contrasting

confidence: 54%

Healthcare workers with tuberculosis infected during work

Vries¹,

Šebek²,

Weezenbeek³

2006

Eur Respir J

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“…If future results support our data, additional efforts should be made to provide HCWs with adequate education about infectious is more closely related to the infrastructure and maintenance of the facility than to the number of TB admissions per HCW. (15) Factors related to the increased risk for HCWs include delayed diagnosis, (16) misdiagnosis in the initial evaluation, advanced age, absence of suspicious clinical signs (e.g., coughing), lack or inadequacy of personal protective equipment and preventive measures, and inadequate ventilation, especially in polyvalent hospital wards. (16,17) The control of TB as a nosocomial disease requires, above all, the adoption of collective measures, such as the rapid identification of suspected or confirmed cases of active TB, the rapid implementation of airborne precautions, and the use of surgical masks or N95 respirators by the HCWs.…”

Section: Discussionmentioning

confidence: 99%

“…(15) Factors related to the increased risk for HCWs include delayed diagnosis, (16) misdiagnosis in the initial evaluation, advanced age, absence of suspicious clinical signs (e.g., coughing), lack or inadequacy of personal protective equipment and preventive measures, and inadequate ventilation, especially in polyvalent hospital wards. (16,17) The control of TB as a nosocomial disease requires, above all, the adoption of collective measures, such as the rapid identification of suspected or confirmed cases of active TB, the rapid implementation of airborne precautions, and the use of surgical masks or N95 respirators by the HCWs. (18) Although BCG vaccination has proven effective in reducing the most severe forms of TB, its efficacy in preventing pulmonary TB is variable.…”

Section: Discussionmentioning

confidence: 99%

Tuberculose ativa entre profissionais de saúde em Portugal

et al. 2011

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Objective: To determine the incidence of active tuberculosis (TB) in a cohort of health care workers (HCWs). Methods: Descriptive study of active TB cases identified in an occupational health screening of 6,112 HCWs between 2005 and 2010. Cases of active TB were defined as those in which Mycobacterium tuberculosis was identified by direct microscopy or culture; those in which there were symptoms or clinical signs of TB and necrotizing granuloma, as detected by histology; and those in which the radiological findings were consistent with active TB. Results: Among the 6,112 HCWs evaluated, we identified 62 cases of active TB: pulmonary TB (n = 43); pleural TB (n = 15); lymph node TB (n = 2); pericardial TB (n = 1); and cutaneous TB (n = 1). Seven HCWs were asymptomatic at the time of diagnosis. Of the 62 cases of active TB, 48 developed within the first 10 years of occupational exposure in the workplace, 36 of those occurring within the first 5 years. Physicians and nurses accounted for the highest numbers of cases (22 and 21, respectively). Conclusions: In HCWs employed in Portugal, the TB burden is high. Physicians and nurses are the HCWs who are at the highest risk of developing active TB. We found the risk of developing this disease to be highest in the first years of exposure, as has been reported in previous studies. In high-incidence countries, TB screening of HCWs is important for controlling the transmission of this disease.Keywords: Tuberculosis/diagnosis; Occupational health; Health personnel. Resumo Objetivo: Determinar a incidência de tuberculose (TB) ativa em uma coorte de profissionais de saúde (PS).Métodos: Estudo descritivo dos casos de TB ativa identificados entre 2005 e 2010 no rastreio de medicina do trabalho efetuado em 6.112 PS. Casos de TB ativa foram definidos como aqueles com identificação de Mycobacterium tuberculosis por microscopia direta ou cultura; aqueles com sintomas ou sinais clínicos de TB e granuloma necrotizante, detectado por histologia; e aqueles com achados radiológicos consistentes com TB ativa. Resultados: Dos 6.112 PS avaliados, houve 62 casos de TB ativa (TB pulmonar, em 43; TB pleural, em 15; TB ganglionar, em 2; TB do pericárdio, em 1; TB cutânea, em 1). Sete PS estavam assintomáticos no momento do diagnóstico. Dos 62 casos de TB ativa, a doença ocorreu nos primeiros 10 anos de exposição ocupacional em 48 e nos primeiros 5 anos em 36. A maioria dos casos verificou-se em médicos e enfermeiros (22 e 21, respectivamente). Conclusões: O impacto da TB em PS em Portugal é elevado. Os médicos e enfermeiros são os PS com o maior risco de desenvolver TB ativa. Tal como relatado em estudos prévios, parece haver um risco mais elevado de desenvolver essa doença nos primeiros anos de exposição. Em países de elevada incidência, o rastreio de TB nos PS é importante no controle da transmissão dessa doença.Descritores: Tuberculose/diagnóstico; Saúde do trabalhador; Pessoal de saúde.

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“…El riesgo de adquirir tuberculosis varía según el tipo de instalación; el tiempo de permanencia en el nosocomio; la prevalencia de tuberculosis en la comunidad; el grupo ocupacional de los trabajadores; el área de la instalación en que trabajan; y la efectividad del control (1)(2)(3)(4) . Debido a que el riesgo de adquirir tuberculosis en los hospitales es 2 a 50 veces más que en la comunidad, el profesional de salud encargado de áreas críticas debe estar atento a la posibilidad de que aquellos pacientes que requieren atención de emergencia tengan tuberculosis, no solo para considerar dicho diagnóstico en la aproximación clínica sino para evitar la diseminación de la enfermedad.…”

Section: Introductionunclassified

Detección de tuberculosis en el servicio de emergencia: utilidad de la segunda baciloscopia realizada el mismo día

Tello

Ugarte

Agapito

et al. 2014

Rev Peru Med Exp Salud Publica

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La realización de una baciloscopía el mismo día de la atención del paciente es una estrategia que recientemente ha sido adoptada por la Organización Mundial de la Salud. Nuestro estudio buscó determinar el rendimiento diagnóstico adicional de una segunda baciloscopía tomada en un mismo día en pacientes con síntomas respiratorios, atendidos en el servicio de emergencia de dos hospitales de Lima. Se incluyeron 270 pacientes desde enero a noviembre de 2011, a los cuales se les solicitó dos muestras de esputo con un lapso de dos horas; las muestras fueron procesadas mediante el método de Ziehl Neelsen. La frecuencia de baciloscopías positivas fue del 18,5%. El rendimiento diagnóstico adicional de la segunda baciloscopía fue 20,9%. Considerando la alta frecuencia de tuberculosis diagnosticada por baciloscopía, se sugiere que esta prueba sea incluida de manera rutinaria en las emergencias de los hospitales de Lima Metropolitana.Palabras clave: Tuberculosis; Esputo; Signos y síntomas respiratorios; Perú (Fuente: DeCS BIREME) TUBERCULOSIS DETECTION IN THE EMERGENCY ROOM:UTILITY OF SAME DAY SMEARS ABSTRACTConducting a same day smears is a strategy that has recently been adopted by the World Health Organization. Our study sought to determine the additional diagnostic yield of a second sputum smear taken on the same day among patients with respiratory symptoms, attended at the emergency room from two hospitals in Lima. We included 270 patients from January to November 2011, which were asked two samples of sputum within two hours; the samples were processed by the Ziehl Neelsen method. The frequency of positive sputum smears was 18.5%. The additional diagnostic yield for the second smear was 20.9%. Considering the high prevalence of tuberculosis diagnosed by sputum smear, it is suggested that this test be included routinely in the emergency rooms of hospitals in Lima Metro area. Tecnólogo médico en Laboratorio Clínico; b tecnólogo médico en Urgencias Médicas y Desastres; c microbiólogo; d médico internista magíster en Estadística Aplicada * Este trabajo se basa en la tesis para obtener el grado de bachiller: "Frecuencia de baciloscopías positivas en pacientes con afecciones respiratorias en la unidad de emergencia de dos hospitales de Lima", realizada por GT y MV el 2012.Recibido: 23-03-12 Aprobado: 13-06-12 INTRODUCCIóNLa tuberculosis pulmonar es una enfermedad frecuente en los servicios médicos y los servicios de emergencia. Los servicios de emergencia atienden en condiciones de hacinamiento a una gran cantidad de pacientes, lo que puede favorecer la transmisión de bacilos hacia otros pacientes, y al personal de salud.El riesgo de adquirir tuberculosis varía según el tipo de instalación; el tiempo de permanencia en el nosocomio; la prevalencia de tuberculosis en la comunidad; el grupo ocupacional de los trabajadores; el área de la instalación en que trabajan; y la efectividad del control (1)(2)(3)(4) . Debido a que el riesgo de adquirir tuberculosis en los hospitales es 2 a 50 veces más que en la comunidad, el profesional...

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Hospital Ventilation and Risk for Tuberculous Infection in Canadian Health Care Workers

Abstract: Tuberculin conversion among health care workers was strongly associated with inadequate ventilation in general patient rooms and with type and duration of work, but not with ventilation of respiratory isolation rooms.

Cited by 179 publications

References 49 publications

Healthcare workers with tuberculosis infected during work

Healthcare workers with tuberculosis infected during work

Tuberculose ativa entre profissionais de saúde em Portugal

Detección de tuberculosis en el servicio de emergencia: utilidad de la segunda baciloscopia realizada el mismo día

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