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Use of airborne infection isolation in potential cases of pulmonary tuberculosis

Published online by Cambridge University Press:  16 March 2020

James H. England Open the ORCID record for James H. England [Opens in a new window] ,
Daniel W. Byrne ,
Bryan D. Harris  and
Thomas R. Talbot
James H. England
Affiliation:
Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
Daniel W. Byrne
Affiliation:
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
Bryan D. Harris
Affiliation:
Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
Thomas R. Talbot*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
*
Author for correspondence: Thomas R. Talbot, E-mail: tom.talbot@vumc.org
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Abstract

Objective:

To identify risk factors of patients placed in airborne infection isolation (AII) for possible pulmonary tuberculosis (TB) to better predict TB diagnosis and allow more judicious use of AII.

Methods:

Case-control, retrospective study at a single tertiary-care academic medical center. The study included all adult patients admitted from October 1, 2014, through October 31, 2017, who were placed in AII for possible pulmonary TB. Cases were defined as those ultimately diagnosed with pulmonary TB. Controls were defined as those not diagnosed with pulmonary TB. Those with TB diagnosed prior to admission were excluded. In total, 662 admissions (558 patients) were included.

Results:

Overall, 15 cases of pulmonary TB were identified (2.7%); of these, 2 were people living with human immunodeficiency virus (HIV; PLWH). Statistical analysis was limited by low case number. Those diagnosed with pulmonary TB were more likely to have been born outside the United States (53% vs 13%; P < .001) and to have had prior positive TB testing, regardless of prior treatment (50% vs 19%; P = .015). A multivariate analysis using non–US birth and prior positive TB testing predicted an 18.2% probability of pulmonary TB diagnosis when present, compared with 1.0% if both factors were not present.

Conclusions:

The low number of pulmonary TB cases indicated AII overuse, especially in PLWH, and more judicious use of AII is warranted. High-risk groups, including those born outside the United States and those with prior positive TB testing, should be considered for AII in the appropriate clinical setting.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 5 , May 2020 , pp. 505 - 509
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved

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Footnotes

†

Present affiliation: The Christ Hospital, Cincinnati, Ohio

References

Reported tuberculosis in the United States, 2017. Centers for Disease Control and Prevention website. https://www.cdc.gov/tb/statistics/reports/2017/. Published 2017. Accessed August 12, 2019.Google Scholar
TB Elimination Prgram. Tennesee TB cases and rates by region and county, 2018. Tennessee Department of Health website. https://www.tn.gov/content/dam/tn/health/documents/2018%20Tuberculosis%20Cases%20and%20Rates%20by%20Public%20Health%20Region%20and%20County%20(TTBEP%2003-19-2019).pdf. Published 2018. Accessed August 12, 2019.Google Scholar
Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care facilities, 1994—CDC. Notice of final revisions to the “Guidelines for preventing the transmission of Mycobacterium tuberculosis in healthcare facilities, 1994.” Fed Regist 1994;59:54242–54303.Google Scholar
Jensen, PA, Lambert, LA, Iademarco, MF, Ridzon, R, CDC. Guidelines for preventing the transmission of Mycobacterium tuberculosis in healthcare settings, 2005. MMWR Recomm Rep 2005;54:1–141.Google ScholarPubMed
American Institute of Architects. Guidelines for design and construction of hospital and health care facilities, 2001. Facilities Guidelines Institute website. https://www.fgiguidelines.org/wp-content/uploads/2015/08/2001guidelines.pdf. Published 2001. Accessed August 12, 2019Google Scholar
Haas, DW, Milton, S, Kreiswirth, BN, Brinsko, VL, Bifani, PJ, Schaffner, W. Nosocomial transmission of a drug-sensitive W-variant Mycobacterium tuberculosis strain among patients with acquired immunodeficiency syndrome in Tennessee. Infect Control Hosp Epidemiol 1998;19:635–639.CrossRefGoogle ScholarPubMed
Abad, C, Fearday, A, Safdar, N. Adverse effects of isolation in hospitalised patients: a systematic review. J Hosp Infect 2010;76:97–102.CrossRefGoogle ScholarPubMed
Verlee, K, Berriel-Cass, D, Buck, K, Nguyen, C. Cost of isolation: daily cost of isolation determined and cost avoidance demonstrated from the overuse of personal protective equipment in an acute care facility. Am J Infect Control 2014;42:448–449.CrossRefGoogle Scholar
Harris, PA, Taylor, R, Minor, BL, et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inform 2019;95:103208.CrossRefGoogle ScholarPubMed
Harris, PA, Taylor, R, Thielke, R, Payne, J, Gonzalez, N, Conde, JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009;42:377–381.CrossRefGoogle ScholarPubMed