Tuberculosis In Health Care Workers Research Articles

Cognitive therapy for depression in tuberculosis treatment: protocol for multicentre pragmatic parallel arm randomised control trial with an internal pilot

Introduction and objectivesThere is an unmet need to develop high-quality evidence addressing tuberculosis (TB)-related mental health comorbidity, particularly in the context of lower-middle-income countries. This study aims to examine the...

Canadian tuberculosis health care workers’ perspectives on education and counselling for patients and family members who are born outside of Canada

ABSTRACT Tuberculosis health care workers (TB HCWs) in low incidence settings have important perspectives on providing TB education and counselling to patients and family members born in other countries. The purpose of this qualitative study was to explore HCWs’ perspectives on barriers and facilitators for capacity-building education and counselling with patients and family members born outside of Canada experiencing advanced infectious TB in Calgary, a city in western Canada. Data were collected through semi-structured interviews and field notes and thematically analysed. Twenty-four HCWs representing clerical staff, nurses, physicians, and allied health professionals employed in TB care were interviewed. HCWs described how multi-level barriers such as patients’ fear of death, complex intra-family communication, information-laden appointments, and patients’ precarious employment collided resulting in overwhelmed patients and reduced connection to family. Some HCWs were unsure how to discuss TB stigma with patients and family members. HCWs perceived that increased continuity of care and providing patients and family members with digestible amounts of information earlier were important steps towards better practice. HCWs identified that patients and families could benefit from preparation for initial appointments, increased continuity, and improved patient education materials. HCWs should also receive skills-training to facilitate individual and family counselling.

Vigilância da Tuberculose nos Profissionais de Saúde como contributo na erradicação de uma Pandemia

Introduction/Framework Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. Despite the available treatment, it’s an important driver of global morbidity and mortality. It reaches mainly the lungs but can reach any organ. The main route of infection is inhalation of aerosolized particles or contaminated micro-droplets. Global efforts for early diagnosis and adequate treatment have made it possible to remove Tuberculosis from the worldwide ten leading causes of death in 2019. The worldwide incidence is around ten million, probably underestimated. Tuberculosis represents an often-overlooked pandemic, which remains an important cause of death from an infectious disease whose, in contrast to other infections, incidence has recently risen as occupational disease. Methodology It’s a narrative review of the national and international guidelines about Tuberculosis in healthcare workers, with an adaptation to the Portuguese reality using estimations from countries with a similar disease incidence. Contents The World Health Organization argues that the benefit of screening and treating Latent Tuberculosis Infection outweighs the individual risks and therefore should be performed whenever possible. Following these guidelines, the Portuguese health council (Direção-Geral da Saúde) determined that health institutions, within the scope of health surveillance of their workers, must adopt procedures that allow for the early detection of Tuberculosis and Latent Tuberculosis Infection. Thus, the Occupational Medicine Services are responsible for assessing and manage the professional exposure to this biological agent. The End TB Strategy program aspires to the worldwide eradication of Tuberculosis by 2035, aiming to reduce Tuberculosis incidence and mortality by 80 and 95%, respectively, as well as universal access to proper treatment. Discussion and Conclusions The authors argue that the institutional contribution with the reinforcement of hospital infection control measures, the implementation of regular occupational Tuberculosis surveillance programs and the containment of the disease, through timely screening after unprotected exposure, are essentials measures for the achievement of the ambitious outlined goals. Regardless of their job model, these programs should be applied to all workers, contributing to the maintenance of their health, the main Occupational Medicine’s goal. Finally, the authors share ten common questions from daily basis clinical practice and present methodological suggestions. KEY-WORDS: Labor Health Surveillance; Healthcare workers; Prevention of Occupational Diseases; Screening; Tuberculosis; Latent Tuberculosis Infection.

Modelling the effect of infection prevention and control measures on rate of Mycobacterium tuberculosis transmission to clinic attendees in primary health clinics in South Africa

BackgroundElevated rates of tuberculosis in healthcare workers demonstrate the high rate of Mycobacterium tuberculosis (Mtb) transmission in health facilities in high-burden settings. In the context of a project taking a...

Rate of History of Tuberculosis Among Healthcare Workers in Turkey: A Cross-Sectional Study.

Healthcare workers (HCWs) possess a high risk for both latent tuberculosis infection (LTBI) and active disease. This study aimed to investigate tuberculosis (TB) disease history in hospital staff working in healthcare institutions in the Eastern Black Sea Region of Turkey. This study included 460 HCWs employed in 5 hospitals in the Eastern Black Sea Region of Turkey. Between May 01 and July 31, 2016, the participants were asked to answer a questionnaire, including data about TB history. The data about family TB history, Bacilli Calmette-Guerin (BCG) vaccination, or tuberculin skin test (TST) application before starting work were also evaluated. Of the 460 participants, 69.3% were women (n=319) and 30.7% (n=141) were men. The mean age was 32 (17-63) years. A total of 8 participants (1.7 %) had TB history. There was no statistically significant relationship between TB history and age, sex, body mass index (BMI), smoking habits, or presence of comorbidities (p>0.05 for all variables); family history of TB (p<0.001) and TST positivity (p<0.001) were significantly higher in participants with a TB history. Each participant was checked for the presence of both BCG scar and TST positivity. No difference was noted between positive TB history and negative HCWs (p>0.05). The duration of work (years) was higher in participants with a TB history. The p value was very close but did not reach the limits of significance (p=0.059). In this study, the rate of TB among HCWs was 1.7% (8 of 460 HCWs). Family history of TB and TST positivity are strong predictors of TB in HCWs.

Meta-analysis of latent tuberculosis in healthcare workers in Iran: a retrospective review

Here we review the status of latent tuberculosis (LTB) in Iranian healthcare workers (HCWs). A literature search was conducted using keywords according to the Preferred Reporting Items for Systematic Review and Meta-Analyses instructions. Cross-sectional studies published from 1 January 2000 through 1 January 2019 were retrieved. Meta-analysis was performed using Comprehensive Meta-Analysis software using the random effects model, Cochran's Q and I2 tests. Publication bias was estimated by funnel plot and Egger's linear regression test. Among 774 articles retrieved in the primary literature search, 21 studies met the eligibility criteria. No publication bias was observed among the included studies (p=0.07). The prevalence of LTB ranged from 7% to 63% in Iranian HCWs from different geographical areas. The overall combined prevalence of LTB among Iranian HCWs was 30.9% (95% confidence interval 24.2 to 38.5). Also, 52.4% of the included studies showed a significant correlation between occupation and LTB incidence (p<0.05). The prevalence of LTB was high among Iranian HCWs. This requires developing comprehensive information databases and surveillance systems for detecting LTB among HCWs. It is also essential to periodically screen for LTB in HCWs to provide a timely diagnosis of the infection. It is recommended to perform a tuberculin skin test, a useful tool for screening and treatment of LTB, on an annual basis in HCWs.

A Cross sectional Study to access Knowledge of Tuberculosis in Healthcare Workers in Tertiary Care Hospital, India

A Cross sectional Study to access Knowledge of Tuberculosis in Healthcare Workers in Tertiary Care Hospital, India

Tuberculosis latent infection in health care workers: oxidative stress and Quantiferon-TB Plus

Abstract Background This study moves from recent evidences highlighting: 1) the high sensitivity of Mycobacterium tuberculosis (MT) to perturbation of redox homeostasis induced by oxidative stress; 2) the improvement of Tuberculosis (TB) diagnosis following the introduction of Quantiferon-TB Plus (QFT-Plus) assay. Methods The QFT-Plus diagnostic performance and the blood antioxidant capacity, expressed as ratio between oxidized (GSSG) and reduced (GSH) forms of glutathione, were determined on three selected populations (40 Health care workers (HCWs) controls, 63 latent TB HCWs, 8 active TB patients). Quantitative Real Time PCR analysis on leukocytes of active TB patients was also performed, in order to identify “redox profiles” of genes mainly involved in the antioxidant response. Results 1) The glutathione homeostasis was shifted towards an oxidative status in active TB patients respect to controls, as evidenced by the significant decrease of the ratio between free and total GSH, an indirect index of oxidative stress. More reducing conditions were observed in latent TB subjects. 2) The expression profiles of antioxidant genes confirmed the major susceptibility of active TB patients to oxidative stress compared to controls, and highlighted a great individual variability. 3) The diagnostic performance of QFT-Plus test present a moderate concordance with QFT-GIT one, in this preliminary phase. Conclusions Glutathione has anti-mycobacterial effects in its reduced form GSH, thus the quantification of Free/Total GSH ratio may represent a systemic marker of TB infection and be useful in developing combined therapies. Moreover, the identification of personalized redox profiles will additionally provide an individual antioxidant response to the infection. This project was funded by the Ministry of Health (RF 2016) Key messages LTBI management represents an objective of primary importance in the field of occupational medicine in order to define a personalized prevention in HCW. A new approach that combines biochemical determinations of redox biomarkers and gene expression in blood will be a novel biomarkers of tuberculosis.

Risk Factors for Occupational Transmission of Tuberculosis among Healthcare Workers in Zambia

Healthcare workers (HCWs) play a critical role in the management and control of nosocomial transmission of tuberculosis (TB). At the same time, working in TB healthcare facilities such as hospital wards, diagnostic and treatment facilities increases the risk of acquiring TB due to occupational exposure in HCWs. The risk is further heightened in high TB prevalence populations, such as Zambia, as HCWs are exposed both occupationally and in the community. This review aims to provide a better understanding of the risk factors associated with occupational transmission of TB in HCWs in Zambia, by synthesising available data on TB in HCWs in Zambia and the surrounding region. A search of peer reviewed original research on the transmission of TB among HCWs in Zambia was conducted in PubMed and Google Scholar. Studies were eligible for inclusion in the analysis if they described TB amongst HCWs in Zambia, risk factors for TB in HCWs, and nosocomial transmission of TB in Zambia and the surrounding region. The prevalence of TB in HCWs has been demonstrated to be higher than that of the general population. Transmission of TB in healthcare facilities is driven by several factors centred on the lack of adherence to TB infection prevention and control (IPC) practices. Nosocomial transmission of TB in HCWs is further driven by the HIV epidemic and the rise in lifestyle diseases such as diabetes mellitus. However, there is very scarce data on the association of diabetes mellitus and TB among HCWs in Zambia. Prolonged contact with TB patients on wards has been demonstrated to play a vital role in occupational transmission of TB amongst nurses in Zambia. To curb the transmission of TB in HCWs several measures will require implementation such as; administrative support, IPC training and annual TB and HIV screening for all HCWs.

Comparison of Latent Tuberculosis Infections among General versus Tuberculosis Health Care Workers in Myanmar

Health care workers (HCWs) in high tuberculosis (TB) prevalence countries have to care for many cases, thus increasing their risk of infection. The objective of the study was to compare the prevalence of latent TB infection (LTBI) between general HCWs and TB HCWs, and also to explore the associated factors. A cross-sectional study was conducted in Nay Pyi Taw, Myanmar from September 2019 to January 2020. Staff working at two general hospitals were recruited. Those allocated for TB care were classified as TB HCWs, while the remaining were classified as general HCWs. Participants were interviewed using a structured questionnaire, and screened for LTBI using a tuberculin skin test (TST). Individuals who had an induration of 10 mm or more with normal chest radiograph were regarded as having LTBI. The prevalence of LTBI among general HCWs was 2.04 times higher than that of TB HCWs (31.2% vs. 15.3%, p < 0.001). The associated factors for LTBI included low education level, duration of work experience ≥ 10 years, a low knowledge of regular TB screening, and teaching cough etiquette to TB patients. The higher prevalence of LTBI in the general HCWs in this study was due to confounding by education and experience. After adjustment for these, we have no evidence to support that either group of HCWs had higher LTBI risk.

Tuberculosis in Health Care Workers and the Impact of Implementation of Hospital Infection-Control Measures.

Background: Most studies that have evaluated the impact of infection-control measures (ICM) reported a decrease in latent tuberculosis (TB) and not in TB. The objective of this study was to evaluate the impact of ICM on TB incidence among Health Care Workers (HCW's). Methods: We conducted a retrospective record review study in a general, tertiary care, university-affiliated hospital. All TB case reports among HCWs in the hospital from 2005 to 2018 were reviewed. The TB incidence was measured before and after 2012 to evaluate the impact of ICM implemented. Findings: In total, there were 53 TB cases. The number of TB cases before and after the implementation of ICM was 42 (incidence: 100.0 cases/100,000 HCWs/year) and 11 (incidence: 26.2 cases/100,000 HCWs/year), respectively (p < .0001). Conclusions/Application to Practice: TB incidence among HCWs reduced significantly after the implementation of ICM. The establishment of ICM, such as written TB infection control plan, monitoring, screening, training, and education, can reduce TB incidence.

Tuberculosis Healthcare Workers: There Goes My Hero.

Tuberculosis Healthcare Workers: There Goes My Hero.

Risk factors for pulmonary tuberculosis in health-care workers. Hospital Nacional Dos de Mayo. Lima, Perú

espanolObjetivo: Determinar los factores de riesgo para tuberculosis pulmonar en trabajadores de salud del Hospital Nacional Dos de Mayo. Lima, Peru. Materiales y metodos: Estudio analitico de casos y controles. La poblacion de estudio fueron trabajadores de salud con diagnostico de tuberculosis pulmonar del Hospital Nacional Dos de Mayo. Lima, Peru. Se recolectaron variables epidemiologicas (edad, sexo, comorbilidad, grupo ocupacional), variables ventilatorias (velocidad, direccion y patron del flujo aereo, sistema de ventilacion cerrada) y ambientales (luz ultravioleta, aire acondicionado). Se utilizo analisis univariado, se determino el riesgo relativo, estimado por Odds Ratio con su respectivo intervalo de confianza al 95 %. Posteriormente, se utilizo un modelo predictivo de regresion logistica multivariado paso a paso para identificar los factores de riesgo. Se considero el valor de p Resultados: La tasa de incidencia habitual de tuberculosis pulmonar fue de 348 por 100 000. Los factores asociados fueron velocidad del flujo aereo menor de 0,7m/s, presencia de aire acondicionado en los ambientes hospitalarios, elevado grado de hacinamiento (espacio libre menor de 2 m2/persona), edad menor de 40 anos, presencia de al menos una comorbilidad, y el tiempo de trabajo hospitalario menor de 20 anos. Conclusiones: La presencia de alto grado de hacinamiento y el tiempo de trabajo hospitalario menor a 20 anos constituyen importantes factores de riesgo para tuberculosis pulmonar activa en trabajadores de salud del Hospital Nacional Dos de Mayo. EnglishObjective: To determine the risk factors for pulmonary tuberculosis in health-care workers of the Hospital Nacional Dos de Mayo in Lima, Peru. Materials and methods: A case-control analytical study. The study population consisted of health-care workers of the Hospital Nacional Dos de Mayo in Lima, Peru, diagnosed with pulmonary tuberculosis. Epidemiological variables (age, sex, comorbidity, occupational group), ventilatory variables (airflow velocity, direction and pattern; closed ventilation system) and environmental variables (ultraviolet light, air conditioning) were collected. A univariate analysis was performed, and the relative risk was estimated by odds ratio and its corresponding 95 % confidence interval. Subsequently, a multivariate logistic regression predictive model was used step by step to identify the risk factors. A p value Results: The usual incidence rate of pulmonary tuberculosis was 348 per 100,000 health-care workers. The associated factors were airflow velocity less than 0.7 m/s, use of air-conditioning in hospital rooms, high levels of overcrowding (available space less than 2 m2/person), age less than 40 years, presence of at least one comorbidity, and hospital job time less than 20 years. Conclusions: High levels of overcrowding and hospital job time less than 20 years are important risk factors for active pulmonary tuberculosis in health-care workers of the Hospital Nacional Dos de Mayo.

Pulmonary tuberculosis in healthcare workers of the North-West Federal District

The purpose of this study was to investigate trends of morbidity and course of pulmonary tuberculosis in healthcare workers at the North-West Federal District during the period of 2000 – 2017. Methods . This is a retrospective study. Medical records of North-West Federal Research Center of Hygiene and Public Health from the years 2000 – 2017 were analyzed. Results . Cases of pulmonary tuberculosis in healthcare workers were included in the analysis. The highest morbidity of pulmonary tuberculosis was registered in 2006 (19%), 2007 (16%) and 2010 (21%). Information on habitation of tuberculosis patients was of particular interest. Physicians (34%), nurses (54%), cleaning personnel (7%) and technicians (5%) were among healthcare workers with pulmonary tuberculosis. Tuberculosis was diagnosed during preventive examination in 48% and at presentation in 52% of cases. Conclusion . Majority of new cases of pulmonary tuberculosis in healthcare workers were diagnosed at presentation with advanced clinical symptoms. This situation is associated with an increased risk of the infection spread. Preventive measures should be developed in order to diagnose tuberculosis in an earlier stage.

A screening strategy for latent tuberculosis in healthcare workers: Cost-effectiveness and budget impact of universal versus targeted screening.

To evaluate the clinical, cost-efficiency, and budgetary implications of universal versus targeted latent tuberculosis infection (LTBI) screening strategies among healthcare workers (HCWs) in an intermediate tuberculosis (TB)-burden country. Pragmatic cost-effectiveness and budget impact analysis using decision-analytic modeling. A tertiary-care hospital in Singapore. We compared 7 potentially implementable LTBI screening programs including universal and targeted strategies with different screening frequencies. Feasible targeting methods included stratification by country of origin (a proxy for risk of prior TB exposure) and by high-risk occupation. The clinical and financial consequences of each strategy were estimated relative to "no screening" (current practice) and compared to locally appropriate cost-effectiveness thresholds. All analyses were conducted from the hospital's perspective over a 3-year time horizon, based on the typical hospital planning period. Parameter uncertainties were accounted for using sensitivity analyses. In our model, relative to current practice, screening new international hires and triennial screening of existing high-risk workers is most cost-effective (US$58 per quality adjusted life year [QALY]) and decreases active TB cases from 19 to 14. Screening all new hires combined with triennial universal screening, with or without annual high-risk screening or annual universal screening, reduced active TB to a range of 19 to 6 cases, but these strategies are less cost-effective and require substantially higher expenditures. Targeted LTBI screening for HCWs can be highly cost-effective for hospitals in settings similar to Singapore. More inclusive screening strategies (including regular universal screening) can yield better outcomes but are less efficient and may even be unaffordable.

ПРОФЕССИОНАЛЬНОЕ ЗАБОЛЕВАНИЕ ТУБЕРКУЛЕЗОМ В РЯЗАНСКОЙ ОБЛАСТИ ЗА ТРИДЦАТИЛЕТНИЙ ПЕРИОД

The objective of the study : a retrospective study of occupational tuberculosis cases in Ryazan Region. Subjects and methods . The data of all health care workers with occupational tuberculosis (137 people) in Ryazan Region from 1978 to 2016 were analyzed. Results . From 1995 to 2008, the epidemic situation was highly unfavorable with a high frequency of occupational tuberculosis in health care workers in Razyan and Razyan Region, when every year from 3 to 15 workers developed tuberculosis, and the incidence reached 230.7 per 100,000 medical workers (2001). From 2011 to 2016, there were very few cases of the occupational disease, in 2015, there were no such cases at all. Among medical doctors, who developed occupational tuberculosis, 50% was TB doctors and 26% was doctors of Forensic Medicine Bureau. One of the positive aspects was the timely detection of tuberculosis in health care workers (in 98.6% of cases).

High tuberculosis transmission rate in children with nursery exposure to undetected pulmonary tuberculosis.

Nursery for newborns in Busan, Republic of Korea. To evaluate tuberculosis (TB) transmission from a health care worker with active pulmonary TB to neonatal contacts. For the first investigation, infants who had been in the nursery 3 months before the index patient was diagnosed with pulmonary TB were enrolled. After a child who had stayed in the nursery 10 months before the diagnosis of the index patient was diagnosed with tuberculous meningitis, a second contact investigation was conducted. Respectively 315 and 1334 children participated in the first and second investigations. The mean age of the contacts was 66.3 days; the rate of latent tuberculous infection (LTBI) at the first investigation was 42.5% (134/315). Only one infant had an abnormal chest X-ray, and was thought to have pulmonary TB. In the second investigation, the mean age of the participants was 17.6 months. The proportion of children with LTBI was 18.7% (249/1334). The LTBI rate in the present study was much higher than that estimated from other contact investigations. To minimise the risk of nosocomial TB transmission to neonates, screening and management of TB in health care workers should be strengthened.

Occupational tuberculosis in healthcare workers in sub-Saharan Africa: A systematic review

ABSTRACTThis article investigates the incidence, prevalence and factors associated with occupational tuberculosis (TB) in healthcare workers (HCWs) in sub-Saharan Africa (SSA). Studies were extracted from MEDLINE, PsycINFO, CINAHL, Cochrane Library, and SCOPUS databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement from inception to the 2nd of June 2017. Twenty-one studies met the inclusion criteria. The median prevalence of latent TB infection in HCWS was 62% (IQR 22%) and the median incidence of TB disease was 3871/100,000 (IQR 9314/100,000). The risk factors associated with LTBI or active TB disease were workplace, history of contact with TB patients, and longer duration of employment. The findings of this review demonstrate that the risk of acquiring TB among HCWs in SSA is high. This may impact on the recruitment, longevity and retention of HCWs.

Göğüs Hastalıkları Hastanesi Personelinde Latent Tüberkülozun Değerlendirilmesi

Göğüs Hastalıkları Hastanesi Personelinde Latent Tüberkülozun Değerlendirilmesi

Tuberculosis in healthcare workers, Scotland.

In an attempt to explore healthcare worker acquisition of tuberculosis infection, we conducted population-based surveillance of all cases recorded as healthcare workers reported to Enhanced Surveillance of Mycobacterial Infection from 2000 to 2015. Over the study period, the mean incidence rate of tuberculosis among all healthcare workers was 15.4 per 100,000 healthcare workers. However, the incidence rate of tuberculosis amongst those healthcare workers born outside the UK was 164.8 per 100,000 compared with 5.0 per 100,000 UK-born healthcare workers. Fifty-seven per cent of all non-UK-born healthcare workers were diagnosed within five years of their arrival in the UK and would have been new entrants to the NHS. An effective new entrant occupational health screening programme for latent tuberculosis infection may have prevented some of these active cases of infection.