Protecting Health Care Workers From Tuberculosis, 2013: ACOEM Medical Center Occupational Health Section Task Force on Tuberculosis and Health Care Workers

Delayed tuberculosis diagnosis and costs of contact investigations for hospital exposure: New York City, 2010-2014

BACKGROUND

A delayed diagnosis of tuberculosis (TB) in the hospital may lead to nosocomial exposure, placing employees and other patients at risk. A lack of prompt infection control measures for suspected cases at the time of admission may require complicated and expensive contact investigations. The purpose of this study was to estimate the person-hour costs required by infection control staff to investigate a single hospital-based TB exposure.

METHODS

Electronic data were extracted from 2 tertiary hospitals and 1 community hospital in a large health care system in metropolitan New York City to identify pulmonary TB cases unsuspected at admission. All cases were reviewed by infection prevention and control (IPC) staff to identify exposures.

RESULTS

From 2010-2014, 34 pulmonary TB cases which necessitated a contact investigation were identified. IPC staff calculated an average of 15-20 hours of work per exposure plus 30 minutes of follow-up for each exposed staff member. For exposures, time from admission to isolation averaged 3.3 days, with a mean of 41 staff exposed per patient and an approximate resource usage of 38 person-hours.

CONCLUSIONS

Contact investigations are costly to the health care system. In a low-prevalence country, such as the United States, it is still important that health care providers are trained to think TB.

Tuberculosis in Enclosed Populations

Transmission of tuberculosis (TB) is most effective in close contact indoor environments in various congregate settings including health care facilities, homeless shelters, correctional facilities, long-term care facilities, as well as community settings such as homes, schools, workplaces, and various modes of transportation. Outbreaks are fueled by numerous factors including the HIV epidemic, ease of global travel, unstable socio-economic and/or political situations, and lapses in response to potentially infectious patients. Organized approaches to TB control include an appropriate index of suspicion, identification and isolation of contagious patients in appropriate facilities, use of environmental controls, and personal protective equipment in accordance to national and international published guidelines. These all require tailoring to the various settings where TB is encountered using a determination of risk. Concerted efforts at the local, regional, national, and international levels at identifying patients with active disease, enforcing completion of treatment, and testing and fully treating patients with latent TB infection are paramount in reducing TB burden and continued transmission.

Negative Tuberculin Skin Test and Prediction of Reversion of QuantiFERON Interferon Gamma Release Assay in US Healthcare Workers

QuantiFERON tuberculosis tests (QFT) reverted in (612) 77% of 1,094 low-risk healthcare workers (HCW) testing less than 1.16 IU/mL. Of HCW testing greater than 1.1 IU/mL, 33 (59%) of 56 with negative tuberculin skin tests (TST) reverted vs 8 (6%) of 125 with positive TSTs. Retesting low-risk QFT-positive and TST-negative HCW is prudent.

Infect. Control Hosp. Epidemiol. 2016;37(4):478–482

Healthcare Worker Preferences for Active Tuberculosis Case Finding Programs in South Africa: A Best-Worst Scaling Choice Experiment

Objective

Healthcare workers (HCWs) in South Africa are at a high risk of developing active tuberculosis (TB) due to their occupational exposures. This study aimed to systematically quantify and compare the preferred attributes of an active TB case finding program for HCWs in South Africa.

Methods

A Best–Worst Scaling choice experiment estimated HCW’s preferences using a random-effects conditional logit model. Latent class analysis (LCA) was used to explore heterogeneity in preferences.

Results

“No cost”, “the assurance of confidentiality”, “no wait” and testing at the occupational health unit at one’s hospital were the most preferred attributes. LCA identified a four class model with consistent differences in preference strength. Sex, occupation, and the time since a previous TB test were statistically significant predictors of class membership.

Conclusions

The findings support the strengthening of occupational health units in South Africa to offer free and confidential active TB case finding programs for HCWs with minimal wait times. There is considerable variation in active TB case finding preferences amongst HCWs of different gender, occupation, and testing history. Attention to heterogeneity in preferences should optimize screening utilization of target HCW populations.

Tuberculosis Screening of New Hospital Employees

Selection of the most suitable test(s) for detection of Mycobacterium tuberculosis (TB) infection should be based on purpose, setting, effectiveness, and cost. Two tests are available to screen for latent TB: the tuberculin skin test (TST) and the more recent interferon-gamma release assays (IGRAs). Based on the administrative, logistic, and technical ease of use, an IGRA trial was initiated by the occupational health department at an urban Veteran's Administration health care facility for TB screening of new employees. As a result, new employees completing the pre-placement process within the organization's designated 14 days increased from 77% to 97%, new employee clearance to work time decreased from 13.18 to 5.91 days, and new employee TB screening costs were reduced by 40%. The IGRA is an acceptable alternative to the TST and has significant potential to improve the process of pre-placement TB screening.