Job‐related risk of latent tuberculosis infection in a homogeneous population of hospital workers in a low incidence area

Franchi, Alberto; Diana, O. Evi; Franco, Giuliano

doi:10.1002/ajim.20680

Cited by 11 publications

(9 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Working in gynecology/obstetrics (OR 2.46, 95% CI 1.14-5.40) wards was another significant predictor for LTBI. Our findings are consistent with prior studies where HCWs from gynecology and obstetrics wards were at increased risk of LTBI [52]. A perception exists that the gynecology and obstetrics ward has a low risk of TB transmission [52,53].…”

Section: Plos Onesupporting

confidence: 93%

A tuberculin skin test survey among healthcare workers in two public tertiary care hospitals in Bangladesh

et al. 2020

View full text Add to dashboard Cite

In Bangladesh, there is currently no data on the burden of latent TB infection (LTBI) amongst hospital healthcare workers (HCWs). This study aimed to determine the prevalence of LTBI and compare the prevalence among HCWs in two public tertiary care hospitals. Between September 2018 and August 2019, we conducted a cross-sectional study in two public tertiary care general hospitals. Using a survey and tuberculin skin test (TST), we assessed risk factors for LTBI, adjusting for known and plausible confounders. In addition, a facility assessment was undertaken to understand the implementation of relevant IPC measures. The prevalence of LTBI among HCWs was 42%. HCWs spent a median of 6 hours (SD = 1.76, IQR 2.00) per day and attended an average of 1.87 pulmonary TB patients per week. HCWs did not receive any TB IPC training, the wards lacked a symptom checklist to screen patients for TB, and no masks were available for coughing patients. Seventy-seven percent reportedly did not use any facial protection (masks or respirators) while caring for patients. In the multivariable model adjusting for hospital level clustering effect, TST positivity was significantly higher among HCWs aged 35–45 years (aOR1.36, 95% CI: 1.06–1.73) and with >3 years of service (aOR 1.67, 95% CI: 1.62–1.72). HCWs working in the medicine ward had 3.65 (95% CI: 2.20–6.05) times, and HCWs in the gynecology and obstetrics ward had 2.46 (95% CI: 1.42–4.27) times higher odds of TST positivity compared to HCWs working in administrative areas. This study identified high prevalence of LTBI among HCWs. This may be due to the level of exposure to pulmonary TB patients, and/or limited use of personal protective equipment along with poor implementation of TB IPC in the hospitals. Considering the high prevalence of LTBI, we recommend the national TB program consider providing preventative therapy to the HCWs as the high-risk group, and implement TB IPC in the hospitals.

show abstract

Section: Plos Onesupporting

confidence: 93%

A tuberculin skin test survey among healthcare workers in two public tertiary care hospitals in Bangladesh

et al. 2020

View full text Add to dashboard Cite

show abstract

“…For example, in a study on 2,028 HCWs in Germany (a low-incidence country), the prevalence of LTBI increased with the duration of employment, going from 5.4% in the subgroup with less than 5 years of employment, to 12.7% in those with more than 20 years in the healthcare sector; moreover, age was found to be the most important risk factor linked to a positive IGRA result (>55 years; OR: 14.7; 95% CI: 5.1–42.1) [23]. Both mean age and years of employment of the personnel enrolled in the present study (56.1 ± 8 and 24.8 ± 9.8 years) were higher than in the HCWs enrolled by Franchi and colleagues (39 ± 9 and 13 ± 8 years), who reported a much lower prevalence of LTBI [18]. The association between age and the prevalence of LTBI is also confirmed by data collected on healthcare students.…”

Section: Discussionmentioning

confidence: 61%

“…In other reports on HCWs conducted in Italy and other low-incidence countries, the prevalences of TB and LTBI varied depending on the country and the type of population sample studied. For example, Franchi and colleagues evaluated 1,755 HCWs in Italy in 2004, diagnosing LTBI in 6% of cases [18]; in a study conducted in France (a low-incidence country with 5.2 cases of TB per 100,000 inhabitants in 2006), 18.9% of 148 HCWs had a positive IGRA result [19]: and in a study on 134 HCWs in Spain (another low-incidence country), the pevalence of LTBI was 11.2% [20]. By contrast, a study on 2,884 hospital workers in Portugal (a high-incidence country, with 32 cases/100,000/year) reported a very high prevalence of LTBI (i.e., 29.5%) [21].…”

Section: Discussionmentioning

confidence: 99%

“…For example, Franchi and colleagues found that TST reactivity correlated with age (≥47 years) and the male gender [18]; Durando and colleagues reported an association with being born in a country with a high incidence of TB [25]; and a study on German HCWs identified associations with being foreign-born (OR: 1.99; 95% CI: 1.4–2.8), having TB in the individual’s own history (OR: 4.96; 95% CI: 1.99–12.3), and a having a previous positive TST result (OR: 3.5; 95% CI: 2.4–4.98) [23]. However, in the present study on Italian-born HCWs of relatively high age and years of employment, we did not identify any factor associated with LTBI.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Prevalence of latent tuberculosis infection in healthcare workers at a hospital in Naples, Italy, a low-incidence country

Lamberti

Muoio

Arnese

et al. 2016

J Occup Med Toxicol

View full text Add to dashboard Cite

BackgroundHealthcare workers (HCWs) are at higher risk than the general population of contracting tuberculosis (TB). Moreover, although subjects with latent TB infection (LTBI) are asymptomatic and are not infectious, they may eventually develop active disease. Thus, a fundamental tool of TB control programs for HCWs is the screening and treatment of LTBI.MethodsFrom January 2014 to January 2015, hospital personnel at Azienda Ospedaliera Universitaria, Naples, Italy, were screened for TB. To this end, a tuberculin skin test (TST) was administered as an initial examination, unless when contraindicated, in which case the QuantiFERON® TB-Gold (QFT) assay was performed. Moreover, QFT was carried out on all TST-positive cases to confirm the initial result.ResultsOf 628 personnel asked to participate, 28 (4.5%) denied consent, 533 were administered TST as the baseline examination, and 67 were tested only with QFT. In the TST group, 73 (13.2%) individuals were found positive, 418 (78.4%) were negative, and 42 (7.9%) were absent for the reading window; QFT confirmed the result in 39 (53.4%) TST-positive individuals. In the QFT-only group, 44 (65.7%) individuals were found positive. All TST- and/or QFT-positive subjects were referred for chest X-ray and examination by an infectious diseases specialist. None were found to have active TB, and were thus diagnosed with LTBI.ConclusionsAlthough Italy is a low-incidence country regarding TB, our findings suggest that the prevalence of LTBI in HCWs may be relatively high. As a result, active screening for TB and LTBI is needed for these workers.Electronic supplementary materialThe online version of this article (doi:10.1186/s12995-016-0141-6) contains supplementary material, which is available to authorized users.

show abstract

“…One was a study with a homogeneous population of healthcare workers in a low-incidence area in Italy. Franchi and colleagues [37] found a low prevalence rate (6%). Working in microbiology (OR 4.16, 95% CI 1.27-13.6), dialysis/nephrology (OR 2.52, 95% CI 1.36-4.65), gynaecology/obstetrics (OR 2.46, 95% CI 1.24-4.86) and age >47 years (OR 1.98, 95% CI 1.14-3.46) were significant predictors for TB infection [30].…”

Section: Discussionmentioning

confidence: 99%

Risk of latent TB infection in individuals employed in the healthcare sector in Germany: a multicentre prevalence study

et al. 2010

View full text Add to dashboard Cite

BackgroundHealthcare workers are still recognised as a high-risk group for latent TB infection (LTBI). Therefore, the screening of people employed in the healthcare sector for active and LTBI is fundamental to infection control programmes in German hospitals. It was the aim of the study to determine the prevalence and putative risk factors of LTBI.MethodsWe tested 2028 employees in the healthcare sector with the QuantiFERON-Gold In-tube (QFT-IT) test between December 2005 and May 2009, either in the course of contact tracing or in serial testing of TB high-risk groups following German OSH legislation.ResultsA positive IGRA was found in 9.9% of the healthcare workers (HCWs). Nurses and physicians showed similar prevalence rates (9.7% to 9.6%). Analysed by occupational group, the highest prevalence was found in administration staff and ancillary nursing staff (17.4% and 16.7%). None of the individuals in the trainee group showed a positive IGRA result. In the different workplaces the observed prevalence was 14.7% in administration, 12.0% in geriatric care, 14.2% in technicians (radiology, laboratory and pathology), 6.5% in admission ward staff and 8.3% in the staff of pulmonary/infectious disease wards. Putative risk factors for LTBI were age (>55 years: OR14.7, 95% CI 5.1-42.1), being foreign-born (OR 1.99, 95% CI 1.4-2.8), TB in the individual's own history (OR 4.96, 95% CI 1.99-12.3) and previous positive TST results (OR 3.5, 95% CI 2.4-4.98). We observed no statistically significant association with gender, BCG vaccination, workplace or profession.ConclusionThe prevalence of LTBI in low-incidence countries depends on age. We found no positive IGRA results among trainees in the healthcare sector. Incidence studies are needed to assess the infection risk. Pre-employment screening might be helpful in this endeavour.

show abstract

Job‐related risk of latent tuberculosis infection in a homogeneous population of hospital workers in a low incidence area

Abstract: A higher risk of latent infection can be demonstrated in well-defined groups of HCWs.

Cited by 11 publications

References 32 publications

A tuberculin skin test survey among healthcare workers in two public tertiary care hospitals in Bangladesh

A tuberculin skin test survey among healthcare workers in two public tertiary care hospitals in Bangladesh

Prevalence of latent tuberculosis infection in healthcare workers at a hospital in Naples, Italy, a low-incidence country

Risk of latent TB infection in individuals employed in the healthcare sector in Germany: a multicentre prevalence study

Contact Info

Product

Resources

About