Tuberculosis exposure of patients and staff in an outpatient hemodialysis unit

Linquist, Jeanne A.; Rosaia, Catherine M.; Riemer, Becky; Heckman, Kathy; Alvarez, F González

doi:10.1067/mic.2002.123394

Cited by 20 publications

(29 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The accurate description of contact patterns between individuals is crucial to this end, as it can help to understand the possible transmission dynamics and the design principles for appropriate control measures. In particular, the mutual exposures between patients and healthcare workers (HCWs) have been documented for bacterial and viral transmission since decades [1,2,3]. Transmission might be the result of effective contact, as in the cases of S. aureus [4,5], K. pneumoniae [6] or rotavirus [7], of exposure to contaminated aerosols, as for M. tuberculosis [8], or the result of exposure to droplets, as for influenza [9].…”

Section: Introductionmentioning

confidence: 99%

Estimating Potential Infection Transmission Routes in Hospital Wards Using Wearable Proximity Sensors

et al. 2013

View full text Add to dashboard Cite

BackgroundContacts between patients, patients and health care workers (HCWs) and among HCWs represent one of the important routes of transmission of hospital-acquired infections (HAI). A detailed description and quantification of contacts in hospitals provides key information for HAIs epidemiology and for the design and validation of control measures.Methods and FindingsWe used wearable sensors to detect close-range interactions (“contacts”) between individuals in the geriatric unit of a university hospital. Contact events were measured with a spatial resolution of about 1.5 meters and a temporal resolution of 20 seconds. The study included 46 HCWs and 29 patients and lasted for 4 days and 4 nights. 14,037 contacts were recorded overall, 94.1% of which during daytime. The number and duration of contacts varied between mornings, afternoons and nights, and contact matrices describing the mixing patterns between HCW and patients were built for each time period. Contact patterns were qualitatively similar from one day to the next. 38% of the contacts occurred between pairs of HCWs and 6 HCWs accounted for 42% of all the contacts including at least one patient, suggesting a population of individuals who could potentially act as super-spreaders.ConclusionsWearable sensors represent a novel tool for the measurement of contact patterns in hospitals. The collected data can provide information on important aspects that impact the spreading patterns of infectious diseases, such as the strong heterogeneity of contact numbers and durations across individuals, the variability in the number of contacts during a day, and the fraction of repeated contacts across days. This variability is however associated with a marked statistical stability of contact and mixing patterns across days. Our results highlight the need for such measurement efforts in order to correctly inform mathematical models of HAIs and use them to inform the design and evaluation of prevention strategies.

show abstract

Section: Introductionmentioning

confidence: 99%

Estimating Potential Infection Transmission Routes in Hospital Wards Using Wearable Proximity Sensors

et al. 2013

View full text Add to dashboard Cite

show abstract

“…Group A was also subdivided according to the pathologies, and subgroup A1 behaved differently from subgroups A2 and A3, both with positivity similar to that of group B. Subgroup A1, comprised by RA patients, showed a 4% prevalence of PPD reaction, much lower than that of any subgroup of chronic patients, including that of HIV positive patients and hemodialysis patients, whose response to late hypersensitivity tests, as already recognized in several studies, is jeopardized. 24,25,26,27,28,29 Two recent Brazilian studies about response to PPD in rheumatologic patients candidate to immunobiologic therapy have revealed an attenuated response to PPD in RA patients, 16,30 similar to the international findings 31,32 that attribute that abnormality to deficiencies in cell immunity of rheumatologic patients. In the study developed in Recife in 2007, the prevalence of PPD reaction in the comparison group (33.3%) was greater than that in the RA group (14.6%), with a statistically significant difference (P = 0.034).…”

Section: Discussionmentioning

confidence: 70%

Baixa prevalência de PPD reativo prévia ao uso de infliximabe: estudo comparativo em população amostral do Hospital Geral de Fortaleza

Callado¹,

Lima²,

Nobre³

et al. 2011

Rev. Bras. Reumatol.

View full text Add to dashboard Cite

Objective: To identify tuberculosis infection in rheumatic patients on infliximab by use of PPD testing prior to immunobiologic therapy. Methods: This study comprised 157 patients undergoing infliximab treatment and 734 other patients undergoing laboratory screening for tuberculosis infection originating from several services. The Mantoux technique was used for PPD testing, and an induration of at least 5 mm was considered reactive status. Results: In the infliximab group, 13% of the patients reacted to PPD, while, in the other group, 27% of the patients reacted to PPD (χ 2 = 13; P = 0.0003). These patients were divided into categories: adults with chronic diseases, PPD reactivity of 22%; and other controls, PPD reactivity of 31%. This shows the heterogeneous response of that population (χ 2 = 7; P < 0.009). In the infliximab group, subdivided according to pathologies [rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PA)], different reactivity rates were observed, the lowest value occurring among RA patients: (RA x AS: OR = 0.13; CI: 0.03-0.47; χ 2 = 12; P = 0.0004) and (RA x PA: OR = 0.16; CI: 0.02-1.04; χ 2 Yates corrected = 3.6; P = 0.05). The PPD reactivity in the RA subgroup (4%) was also lower as compared with that of the chronic patients group (22%) (OR = 0.16; CI: 0.05-0.49; χ 2 = 14; P = 0.0002), even when reclassified into four subgroups: rheumatology (OR = 0.19; CI: 0.04-0.72), kidney transplantation (OR = 0.16; CI: 0.05-0.51), infectology (OR = 0.21; CI: 0.05-0.75), and other conditions (OR = 0.13; CI: 0.04-0.44). Conclusion: The low prevalence of PPD reaction in this Brazilian population, mainly in chronic patients, with the worst performance among RA patients, shwoed that the test has limited value for diagnosis of tuberculosis infection in candidates to infliximab therapy.

show abstract

“…Articles included in the present review were published from 1974 [ 13 , 14 ] to 2013 [ 41 ] and reported data on incidents that occurred in the USA (66, 56.4%) [ 13 – 15 , 17 , 19 , 20 , 23 , 25 , 32 , 33 , 35 , 38 , 39 ], France (34, 29.0%) [ 26 , 28 , 29 , 34 , 36 , 37 , 43 , 44 , 46 ], UK (5, 4.2%) [ 16 , 18 , 31 , 42 , 45 ], Netherlands (6, 5.1%) [ 22 ], Canada (2, 1.7%) [ 21 , 24 ] Ireland (1, 0.9%) [ 39 ], Japan (1, 0.9%) [ 27 ], Australia (1, 0.9%) [ 41 ] and Italy (1, 0.9%) [ 29 ].…”

Section: Resultsmentioning

confidence: 99%

Tuberculosis Transmission from Healthcare Workers to Patients and Co-workers: A Systematic Literature Review and Meta-Analysis

et al. 2015

View full text Add to dashboard Cite

Healthcare workers (HCWs) are at risk of becoming infected with tuberculosis (TB), and potentially of being infectious themselves when they are ill. To assess the magnitude of healthcare-associated TB (HCA-TB) transmission from HCWs to patients and colleagues, we searched three electronic databases up to February 2014 to select primary studies on HCA-TB incidents in which a HCW was the index case and possibly exposed patients and co-workers were screened.We identified 34 studies out of 2,714 citations. In 29 individual investigations, active TB was diagnosed in 3/6,080 (0.05%) infants, 18/3,167 (0.57%) children, 1/3,600 (0.03%) adult patients and 0/2,407 HCWs. The quantitative analysis of 28 individual reports showed that combined proportions of active TB among exposed individuals were: 0.11% (95% CI 0.04–0.21) for infants, 0.38% (95% CI 0.01–1.60) for children, 0.09% (95% CI 0.02–0.22) for adults and 0.00% (95% CI 0.00–0.38) for HCWs. Combined proportions of individuals who acquired TB infection were: 0.57% (95% CI 7.28E-03 – 2.02) for infants, 0.9% (95% CI 0.40–1.60) for children, 4.32% (95% CI 1.43–8.67) for adults and 2.62% (95% CI 1.05–4.88) for HCWs. The risk of TB transmission from HCWs appears to be lower than that recorded in other settings or in the healthcare setting when the index case is not a HCW. To provide a firm evidence base for the screening strategies, more and better information is needed on the infectivity of the source cases, the actual exposure level of screened contacts, and the environmental characteristics of the healthcare setting.

show abstract

Tuberculosis exposure of patients and staff in an outpatient hemodialysis unit

Cited by 20 publications

References 8 publications

Estimating Potential Infection Transmission Routes in Hospital Wards Using Wearable Proximity Sensors

Estimating Potential Infection Transmission Routes in Hospital Wards Using Wearable Proximity Sensors

Baixa prevalência de PPD reativo prévia ao uso de infliximabe: estudo comparativo em população amostral do Hospital Geral de Fortaleza

Tuberculosis Transmission from Healthcare Workers to Patients and Co-workers: A Systematic Literature Review and Meta-Analysis

Contact Info

Product

Resources

About