TB in healthcare workers in the UK: a cohort analysis 2009–2013

Davidson, J. A. H.; Lalor, Maeve K.; Anderson, Laura; Tamne, Surinder; Abubakar, Ibrahim; Thomas, H Lucy

doi:10.1136/thoraxjnl-2015-208026

Cited by 17 publications

(14 citation statements)

References 10 publications

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“…While nosocomial transmission of tuberculosis (TB) has been relatively uncommon in low TB-burden countries 2 , healthcare workers (HCWs) who routinely perform high-risk procedures such as bronchoscopy, are at increased risk of TB exposure 3 . In addition, international travel has facilitated TB outbreaks in health-care settings.…”

Section: Introductionmentioning

confidence: 99%

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

Png

Yoong

Ong

et al. 2019

Infect. Control Hosp. Epidemiol.

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Objective: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.Design:Pragmatic cost-effectiveness and budget impact analysis using decision-analytic modeling.Setting:A tertiary-care hospital in Singapore.Methods: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.Results: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.Conclusions: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.

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Section: Introductionmentioning

confidence: 99%

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

Png

Yoong

Ong

et al. 2019

Infect. Control Hosp. Epidemiol.

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“…[6][7][8][9][10][11] DNA fingerprinting studies have shown that a substantial proportion of TB in HCWs in low-incidence countries is not a result of occupational exposure in healthcare settings in these countries. 12,13 In the United Kingdom, 85% of HCW TB cases were foreign born, and TB was presumably the result of an infection acquired before starting work in a UK healthcare institution; 13 the infection was likely acquired during healthcare work in the HCW's country of origin. In 3 years (2010-2012), only 10 events (3.3 per year) were identified involving patient-to-HCW transmission.…”

mentioning

confidence: 99%

Analysing Tuberculosis Cases Among Healthcare Workers to Inform Infection Control Policy and Practices

Vries

Hunen

Meerstadt-Rombach

et al. 2017

Infect. Control Hosp. Epidemiol.

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OBJECTIVE To determine the number and proportion of healthcare worker (HCW) tuberculosis (TB) cases infected while working in healthcare institutions in the Netherlands and to learn from circumstances that led to these infections. DESIGN Cohort analysis. METHODS We included all HCW TB patients reported to the Netherlands TB Register from 2000 to 2015. Using data from this register, including DNA fingerprints of the bacteria profile and additional information from public health clinics, HCW TB cases were classified into 4 categories: (1) infected during work in the Netherlands, (2) infected in the community, (3) infected outside the Netherlands, or (4) outside these 3 categories. An in-depth analysis of category 1 cases was performed to identify factors contributing to patient-to-HCW transmission. RESULTS In total, 131 HCW TB cases were identified: 32 cases (24%) in category 1; 13 cases (10%) in category 2; 42 cases (32%) in category 3; and 44 cases (34%) in category 4. The annual number of HCW TB cases (P<.05), the proportion among reported cases (P<.01), and the number of category 1 HCW TB cases (P=.12) all declined over the study period. Delayed diagnosis in a TB patient was the predominant underlying factor of nosocomial transmission in 47% of category 1 HCW TB patients, most of whom were subsequently identified in a contact investigation. Performing high-risk procedures was the main contributing factor in the other 53% of cases. CONCLUSION In low-incidence countries, every HCW TB case should warrant timely and thorough investigation to help further define and fine-tune the HCW screening policy and to monitor its proper implementation. Infect Control Hosp Epidemiol 2017;38:976-982.

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“…15 Therefore, all HCWs from the Philippines should have received OH assessment. Between 2009 and 2013, 11% of HCWs with TB in the UK were born in the Philippines 5 which means targeted OH assessment could have a significant impact on preventing development of active TB disease in this population, and other high TB incidence countries, as well as ensuring early diagnosis and treatment. Indeed a recent study in the North of England identified a high proportion of LTBI among HCWs from high TB incidence countries, including the Philippines.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4] In low incidence countries, such as the UK, TB mainly affects nonnative born HCWs who originate from high TB incidence countries. 5 Despite the considerable annual number of TB cases notified in HCWs in the UK, little evidence of transmission within healthcare settings, with only a few isolated incidents in recent years, exists. 5 In recent decades there has been an expansion, by both the National Health Service (NHS) and private sector healthcare employers, in recruiting HCWs to the UK from abroad, [6][7][8] many of whom originate from high TB incidence countries.…”

Section: Introductionmentioning

confidence: 99%

“…5 Despite the considerable annual number of TB cases notified in HCWs in the UK, little evidence of transmission within healthcare settings, with only a few isolated incidents in recent years, exists. 5 In recent decades there has been an expansion, by both the National Health Service (NHS) and private sector healthcare employers, in recruiting HCWs to the UK from abroad, [6][7][8] many of whom originate from high TB incidence countries. 8,9 UK guidance for HCW occupational health (OH) TB assessment sets out the requirements for pre-employment checks, including latent TB infection (LTBI) testing, in those from high TB incidence countries.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Investigating a tuberculosis cluster among Filipino health care workers in a low-incidence country

Davidson¹,

Thomas²,

Lalor³

et al. 2018

int j tuberc lung dis

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The MIRU-VNTR profile of this cluster probably reflects common endemic strains circulating in the Philippines, with reactivation occurring in the UK. Furthermore, 32-locus typing showed that 24-locus MIRU-VNTR failed to distinguish strain diversity. The lack of OH assessment indicates that latent tuberculous infection could have been identified and treated, thereby preventing active cases from occurring.

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TB in healthcare workers in the UK: a cohort analysis 2009–2013

Cited by 17 publications

References 10 publications

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

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

Analysing Tuberculosis Cases Among Healthcare Workers to Inform Infection Control Policy and Practices

Investigating a tuberculosis cluster among Filipino health care workers in a low-incidence country

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