Examining pulmonary TB patient management and healthcare workers exposures in two public tertiary care hospitals, Bangladesh.

Sayeeda Tarannum,Sayera Banu,Abrar Ahmad Chughtai,Raquel Muñiz-Salazar,Holly Seale,Kamal Ibne Amin Chowdhury,S M Zafor Shafique,Md Saiful Islam,Mohammad Tauhidul Islam,S M Hasibul Islam,Arifa Nazneen

doi:10.1371/journal.pgph.0000064

Abstract

Implementation of tuberculosis (TB) infection prevention and control (IPC) guidelines in public tertiary care general hospitals remain challenging due to limited evidence of pulmonary TB (PTB) patients' duration of hospital stay and management. To fill this evidence gap, this study examined adult PTB patient management, healthcare workers' (HCWs) exposures and IPC practices in two public tertiary care hospitals in Bangladesh.Between December 2017 and September 2019, a multidisciplinary team conducted structured observations, a hospital record review, and in-depth interviews with hospital staff from four adult medicine wards.Over 20 months, we identified 1,200 presumptive TB patients through the hospital record review, of whom 263 were confirmed PTB patients who stayed in the hospital, a median of 4.7 days without TB treatment and possibly contaminated the inpatients wards. Over 141 observation hours, we found a median of 3.35 occupants present per 10 m2 of floor space and recorded a total of 17,085 coughs and 316 sneezes: a median of 3.9 coughs or sneezes per 10 m2 per hour per ward. Only 8.4% of coughs and 21% of sneezes were covered by cloths, paper, tissues, or by hand. The HCWs reportedly could not isolate the TB patients due to limited resources and space and could not provide them with a mask. Further, patients and HCWs did not wear any respirators.The study identified that most TB patients stayed in the hospitals untreated for some duration of time. These PTB patients frequently coughed and sneezed without any facial protection that potentially contaminated the ward environment and put everyone, including the HCWs, at risk of TB infection. Interventions that target TB patients screening on admission, isolation of presumptive TB patients, respiratory hygiene, and HCWs' use of personal protective equipment need to be enhanced and evaluated for acceptability, practicality and scale-up.

Highlights

Public tertiary care hospitals in low-and middle-income countries (LMIC) are generally densely occupied, raising the possibility of infectious and susceptible individuals being colocated in the same area
The dataset underlying the findings described in the Implementation of tuberculosis (TB) infection prevention and control (IPC) guidelines in public tertiary care general hospitals remain challenging due to limited evidence of pulmonary TB (PTB) patients’ duration of hospital stay and management
To fill this evidence gap, this study examined adult PTB patient management, healthcare workers’ (HCWs) exposures and IPC practices in two public tertiary care hospitals in Bangladesh.Between December 2017 and September 2019, a multidisciplinary team conducted structured observations, a hospital record review, and in-depth interviews with hospital staff from four adult medicine wards.Over 20 months, we identified 1,200 presumptive TB patients through the hospital record review, of whom 263 were confirmed PTB patients who stayed in the hospital, a median of 4.7 days without TB treatment and possibly contaminated the inpatients wards

Summary

Introduction

Public tertiary care hospitals in low-and middle-income countries (LMIC) are generally densely occupied, raising the possibility of infectious and susceptible individuals being colocated in the same area. Factors that influence the risk of nosocomial TB infections include the presence of untreated pulmonary TB (PTB) patients, frequency of patients with infectious TB not covering their coughs, inadequate room ventilation, respiratory hygiene, and the inadequacy of TB IPC measures [6, 7]. These PTB patients often remain untreated due to a low index of suspicion and a lack of proper screening and diagnostic evaluation [8]. A lack of screening procedures for patients with presumptive TB on admission may lead to a delayed diagnosis that allows the opportunity for nosocomial TB transmission from untreated PTB patients to other hospital wards’ occupants

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