Predictive Factors and Clinical Impacts of Delayed Isolation of Tuberculosis during Hospital Admission

Abstract

Delayed isolation of tuberculosis (TB) can cause unexpected exposure of healthcare workers (HCWs). This study identified the predictive factors and clinical impact of delayed isolation. We retrospectively reviewed the electronic medical records of index patients and HCWs who underwent contact investigation after TB exposure during hospitalization at the National Medical Center, between January 2018 and July 2021. Among the 25 index patients, 23 (92.0%) were diagnosed with TB based on the molecular assay, and 18 (72.0%) had a negative acid-fast bacilli smear. Sixteen (64.0%) patients were hospitalized via the emergency room, and 18 (72.0%) were admitted to a non-pulmonology/infectious disease department. According to the patterns of delayed isolation, patients were classified into five categories. Among 157 close-contact events in 125 HCWs, 75 (47.8%) occurred in Category A. Twenty-five (20%) HCWs had multiple TB exposures (n = 57 events), of whom 37 (64.9%) belonged to Category A (missed during emergency situations). After contact tracing, latent TB infection was diagnosed in one (1.2%) HCW in Category A, who was exposed during intubation. Delayed isolation and TB exposure mostly occurred during pre-admission in emergency situations. Effective TB screening and infection control are necessary to protect HCWs, especially those who routinely contact new patients in high-risk departments.

Practical Considerations in Hospital Infection Prevention

“…18 Conditions such as malignancy and autoimmune disease are also associated with delayed diagnosis of TB. 19 Clinicians must carefully consider respiratory and constitutional symptoms (cough, weight loss, fatigue) and abnormal chest radiograph findings in patients possessing risk factors for TB including exposure to an infected person, human immunodeficiency virus (HIV) infection, medically underserved populations, immigration from a geographic area with high TB incidence, history of incarceration, and others (Table 1). 20 Hospital inpatient interventions are based on a threelevel hierarchy of control measures: administrative measures, environmental controls, and use of protective equipment (PPE).…”