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Compliance with Postexposure Screening and Treatment of Latent Tuberculosis Infection among Healthcare Workers in a Tertiary Care Hospital in Saudi Arabia

Published online by Cambridge University Press:  10 May 2016

Hanan H. Balkhy ,
Thaddeus L. Miller ,
Saira Ali ,
Jennifer B. Nuzzo ,
Karine Kentenyants ,
Aiman El-Saed  and
Scott J. N. McNabb
Hanan H. Balkhy*
Affiliation:
Infection Prevention and Control Department, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
Thaddeus L. Miller
Affiliation:
School of Public Health, University of North Texas Health Sciences Center, Fort Worth, Texas
Saira Ali
Affiliation:
Infection Prevention and Control Department, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
Jennifer B. Nuzzo
Affiliation:
Center for Biosecurity, University of Pittsburgh Medical Center, Baltimore, Maryland
Karine Kentenyants
Affiliation:
Rollins School of Public Health, Emory University, Atlanta, Georgia
Aiman El-Saed
Affiliation:
Infection Prevention and Control Department, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia Community Medicine Department, Mansoura University, Daqahlia, Egypt
Scott J. N. McNabb
Affiliation:
Rollins School of Public Health, Emory University, Atlanta, Georgia
*
King Saud bin Abdulaziz University for Health Sciences, P.O. Box 22490, Riyadh 11426, Saudi Arabia (balkhyh@hotmail.com)
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Abstract

Background.

Controlling tuberculosis (TB) infection among occupationally exposed healthcare workers (HCWs) may be challenging.

Methods.

We retrospectively reviewed clinical records of HCWs who were exposed to patients diagnosed with infectious TB at King Abdulaziz Medical City, Riyadh, Saudi Arabia, between 2008 and 2010. The collected data included baseline tuberculin skin test (TST) status, potential predictors of TST positivity, postexposure diagnosis of latent TB infection (LTBI), and postexposure compliance with LTBI therapy.

Results.

Thirteen patients were diagnosed with infectious pulmonary TB during the study period. A total of 298 HCWs met our definition for exposure. Exposed HCWs tended to be female (62.9%), non-Saudi (83.9%), nurses (68.6%), or respiratory therapists (24.0%) working in critical care locations (72.8%). Baseline (preemployment) TST documentation existed for 41.3% (123/298). Among those with documented baseline TSTs, 51.2% (63/123) were positive, representing 21.1% (63/298) of all HCWs. Only 48.9% (115/235) of exposed HCWs who had negative or unknown preexposure TST status had their TST tested after exposure. Approximately 46.1% (53/115) of them were diagnosed with postexposure LTBI, and 92.5% (49/53) of them were prescribed LTBI therapy. Among those, 93.9% (46/49) started LTBI therapy; however, 82.6% (38/46) failed to complete the recommended course.

Conclusions.

We found low rates of baseline TST documentation and postexposure screening among exposed HCWs. Compliance with initiating postexposure isoniazid prophylaxis among HCWs was fair, but only a small fraction of those who started prophylaxis completed the recommended course of therapy. These findings suggest substantial opportunities to implement administrative measures to enhance LTBI management among HCWs.

Information

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 2 , February 2014 , pp. 176 - 181
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

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References

1. World Health Organization (WHO), global Tuberculosis Report 2012. Geneva: WHO, 2012. http://www.who.int/iris/bitstream/10665/75938/1/9789241564502_eng.pdf. Accessed April 15, 2013).Google Scholar
2. Raviglione, M, Marais, B, Floyd, K, et al. Scaling up interventions to achieve global tuberculosis control: progress and new developments. Lancet 2012;379(9829):1902–1913.CrossRefGoogle ScholarPubMed
3. Jensen, PA, Lambert, LA, Iademarco, MF, Ridzon, R. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care settings, 2005. MMWR Recomm Rep 2005;54(RR-17):1–141.Google ScholarPubMed
4. Centers for Disease Control and Prevention. Targeted tuberculin testing and treatment of latent tuberculosis infection. MMWR Recomm Rep 2000;49(RR-6):1–51.Google Scholar
5. Costa, JT, Silva, R, Sa, R, et al. Tuberculosis: risk of continued transmission in healthcare workers. Rev Port Pneumol 2010; 16(1):5–21.Google Scholar
6. Al Jahdali, HH, Baharoon, S, Abba, AA, et al. Saudi guidelines for testing and treatment of latent tuberculosis infection. Ann Saudi Med 2010;30(1):38–49.Google Scholar
7. Louther, J, Rivera, P, Feldman, J, Villa, N, DeHovitz, J, Sepkowitz, KA. Risk of tuberculin conversion according to occupation among health care workers at a New York City hospital. Am J Respir Crit Care Med 1997;156(1):201–205.CrossRefGoogle Scholar
8. Baussano, I, Nunn, P, Williams, B, Pivetta, E, Bugiani, M, Scano, F. Tuberculosis among health care workers. Emerg Infect Dis 2011;17(3):488–494.CrossRefGoogle ScholarPubMed
9. Ho, TB, Rayner, CF, Lindfield, T, Young, Y, Whitfield, RJ. Prevalence of TB in healthcare workers in south west London. Thorax 2004;59(11):1002–1003.CrossRefGoogle ScholarPubMed
10. World Health Organization (WHO). WHO Policy on TB Infection Control in Health-Care Facilities, Congregate Settings and Households. Geneva: WHO, 2009.Google Scholar
11. Abbas, MA, AlHamdan, NA, Fiala, LA, AlEnezy, AK, AlQahtani, MS. Prevalence of latent TB among health care workers in four major tertiary care hospitals in Riyadh, Saudi Arabia. J Egypt Public Health Assoc 2010;85(1/2):61–71.Google ScholarPubMed
12. Koshak, EA, Tawfeeq, RZ. Tuberculin reactivity among health care workers at King Abdulaziz University Hospital, Saudi Arabia. East Mediterr Health J 2003;9(5/6):1034–1041.Google Scholar
13. Murad, MA, Abdulmageed, SS. Tuberculosis screening among health sciences students in Saudi Arabia in 2010. Ann Saudi Med 2012;32(5):527–529.CrossRefGoogle ScholarPubMed
14. Saudi Ministry of Health. A Review of Health Situation: Annual Health Statistics Book. Riyadh: Saudi Ministry of Health, 2009. http://www.moh.gov.sa/en/Ministry/Statistics/book/Pages/default.aspx. Accessed April 15, 2013.Google Scholar
15. World Health Organization (WHO). Saudi Arabia Tuberculosis Profile. Geneva: WHO, 2011.Google Scholar
16. Driver, CR, Stricof, RL, Granville, K, et al. Tuberculosis in health care workers during declining tuberculosis incidence in New York State. Am J Infect Control 2005;33(9):519–526.CrossRefGoogle ScholarPubMed
17. Joshi, R, Reingold, AL, Menzies, D, Pai, M. Tuberculosis among health-care workers in low- and middle-income countries: a systematic review. PLoS Med 2006;3(12):e494.Google Scholar
18. Garber, E, San Gabriel, P, Lambert, L, Saiman, L. A survey of latent tuberculosis infection among laboratory healthcare workers in New York City. Infect Control Hosp Epidemiol 2003;24(11):801–806.Google Scholar
19. Horsburgh, CR Jr, Goldberg, S, Bethel, J, et al. Latent TB infection treatment acceptance and completion in the United States and Canada. Chest 2010;137(2):401–409.Google Scholar
20. Kwara, A, Herold, JS, Machan, JT, Carter, EJ. Factors associated with failure to complete isoniazid treatment for latent tuberculosis infection in Rhode Island. Chest 2008;133(4):862–868.CrossRefGoogle ScholarPubMed
21. Parsyan, AE, Saukkonen, J, Barry, MA, Sharnprapai, S, Horsburgh, CR Jr. Predictors of failure to complete treatment for latent tuberculosis infection. J Infect 2007;54(3):262–266.Google Scholar
22. Machado, A Jr, Finkmoore, B, Emodi, K, et al. Risk factors for failure to complete a course of latent tuberculosis infection treatment in Salvador, Brazil. Int J Tuberc Lung Dis 2009;13(6):719–725.Google Scholar
23. Rennie, TW, Bothamley, GH, Engova, D, Bates, IP. Patient choice promotes adherence in preventive treatment for latent tuberculosis. Eur Respir J 2007;30(4):728–735.Google Scholar
24. Lobato, MN, Reves, RR, Jasmer, RM, Grabau, JC, Bock, NN, Shang, N. Adverse events and treatment completion for latent tuberculosis in jail inmates and homeless persons. Chest 2005;127(4): 1296–1303.Google Scholar