Abstract
BackgroundThis study assesses the risk of LTBI at our Hospital among HCWs who have been exposed to TB patients with a delayed diagnosis and respiratory protection measures were not implemented.MethodsAll HCWs exposed to a patient with cultural confirmed pulmonary TB and respiratory protection measures were not implemented were included. Data on TST results performed in the past (defined as T0) were recorded. TST was performed twice: first, immediately after exposure to an index patient (T1) and three months later (T2). The period of time between T0 and T1 was used to calculate he annual rate of tuberculosis infection (ARTI), while le period of time between T1 and T2 was used to calculate the post exposure annual rate of tuberculosis infection (PEARTI).ResultsFourteen index patients were admitted; sputum smear was positive in 7 (58.3%), 4 (28.6%) were non-Italian born patients. 388 HCWs were exposed to index patients, a median of 27 (12-39) HCW per each index patient. One hundred eighty (46.4%) HCWs received BCG in the past. One hundred twenty two HCWs (31%) were TST positive at a previous routine screening and not evaluated in this subset. Among the remaining 255 HCWs with negative TST test in the past, TST at T1 was positive in 11 (4.3%). ARTI was 1.6 (95% CI 0.9-2.9) per 100 PY. TST at T2 was positive in 9 (3.7%) HCWs, that were TST negative at T1. PEARTI was 26 (95% CI 13.6-50) per 100 PY. At univariate analysis, older age was associated with post exposure latent tuberculosis infection (HR 1.12; 95% CI 1.03-1.22, p=0.01).ConclusionsPEARTI was considerably higher among HCWs exposed to index patients than ARTI. These data underscore the overwhelming importance of performing a rapid diagnosis, as well as implementing adequate respiratory protection measures when TB is suspected.
Highlights
This study assesses the risk of Latent tuberculosis infection (LTBI) at our Hospital among Health care worker (HCW) who have been exposed to TB patients with a delayed diagnosis and respiratory protection measures were not implemented
post exposure annual rate of tuberculosis infection (PEARTI) was considerably higher among HCWs exposed to index patients than annual rate of tuberculosis infection (ARTI)
To identify contacts, defined as anyone who was in contact with any index case without respiratory protection measures, epidemiological investigations were conducted in each ward where the index patient was admitted by the infection control team
Summary
This study assesses the risk of LTBI at our Hospital among HCWs who have been exposed to TB patients with a delayed diagnosis and respiratory protection measures were not implemented. Tuberculosis has long been recognized as an important hazard for HCWs [2,3,4], and the risk of latent TB infection is four to six fold greater for those exposed than unexposed to patients with TB [5,6] and increases proportionally with the number of TB admissions in each hospital. In hospitals where infection control measures are applied, ARTI decreases [7] or remains low, despite a moderate number of TB admissions [9,10]. ARTI in HCWs varies between 0.2 and 12% in high income Countries [11]
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