Factors influencing tuberculosis screening in healthcare workers in Portugal

Abstract

Although the incidence of tuberculosis (TB) has increased in healthcare workers (HCWs) [1][2][3], several studies have shown that HCWs are not compliant with screening and/or preventive measures [4][5][6][7]. For example, a Portuguese study found that the estimated TB incidence was three-to seven-fold higher in HCWs than in the general population [8]. Latent TB infection (LTBI) diagnosis and treatment constitute the core of TB elimination, integrating the post-2015 strategies of the World Health Organization [9,10].To evaluate TB screening practices among HCWs and their reasons for nonadherence in Portugal, we developed a survey and distributed it to nurses and physicians from December 25, 2012 to January 31, 2013, closing when we received fewer than one response per day. The survey was anonymous, voluntary and digitally distributed through our network of contacts using a "snowball" distribution method where volunteers subsequently distribute the questionnaire to their contacts and so forth.Continuous data are presented as mean±SD and compared using t-tests. Categorical data are presented as n (%) and compared using the Chi-squared or Fisher's test, as appropriate. Multiple logistic regression analysis was used to identify statistically significant determinants of TB infection, exposure and screening. Crude and adjusted odds ratios and 95% confidence intervals were determined. Goodness-of-fit of the models was evaluated; comparisons with the null model used the difference of deviances, as determined by Chi-squared tests, while comparisons with the saturated model used the difference of deviances, determined using the Chi-squared or Hosmer-Lemeshow test, as appropriate. The area under the receiver operating characteristic (ROC) curve was calculated for each model. All statistical analyses were performed using the R language and software, version 2.12.1 [11]. The level of significance was fixed at 0.05.In Portugal, in 2008, there were 38 932 physicians and 56 859 nurses registered by their respective boards [12].We obtained 2414 responses, of which 399 did not meet the inclusion criteria. Thus, responses from 2015 subjects were analysed; table 1 summarises the results. Of these subjects, 1540 (76.4%) were females and 1133 (56.2%) nurses. Subjects were aged 18-73 years (mean±SD 39.02±10.60 years). 44 (2.2%) subjects had a history of TB (20 before beginning professional activity).

Prevalence of positive TST among healthcare workers in high-burden TB setting in Peru

“…Rather, it is more likely that HCWs overreported having been tested in the last year, instead of underreporting a positive TST. In Portugal, from a sample size of 2015 registered physicians and nurses, a survey reported that 784 (39.5%) were never screened and, of those HCWs, 741 (94.5%) were never offered screening [25]. Moreover, in China, where policies on medical TB surveillance among HCWs have not been implemented, a large study identified 124 HCWs with presumptive active TB, while noting that the screening methods and framework used were not yet optimal for the high-burden of TB in the country [26].…”

Prevalence of positive TST among Healthcare workers in a high-burden TB setting in Peru

“…Only half of our participants had previous active TB screening during the last year; although these were standardized screening procedures by their place of work, we can see how the health center is unable to ensure TB screening for all its workers and some of them may have to access these tests out of pocket. In Portugal, from a sample size of 2015 registered physicians and nurses, a survey reported that 784 (39.5%) were never screened and, of these, 741 (94.5%) were never offered screening [24]. Furthermore, in China, where no policy on medical TB surveillance among HCWs has been implemented, a large study identified 124 HCWs with presumptive active TB while noting that the screening methods and framework used is not yet optimal for the high-burden of TB in the country [25].…”

Análise da produção científica sobre a Tuberculose em Portugal: Revisão Integrativa da literatura

“…Testes de rastreio em profissionais de saúde Foi observado que os testes de detecção não foram oferecidos para a maioria dos profissionais de saúde, indicando insuficiência nas medidas institucionais de controle da TB. Ainda, encontrou-se baixo nível de conhecimento dos trabalhadores acerca da epidemiologia e patogenia da doença, tendo como consequência a resistência dos mesmos à realização dos testes por desinformação (MEIRELES, 2014). Em contraste, osdados da pesquisa realizada por Torres Costa et al (2011) indicaram um ónus de 129,8 por 100.000 profissionais de saúde, ressaltando a importância da realização de testes de detecção em profissionais de saúde, uma vez que o risco de TB ocupacional é conhecido.…”