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

Abstract

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.

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“…In contrast, this group has lower transmission rates to contacts than other groups of infected individuals as a result of frequent health checks. 23 After close scrutiny of the screening data of 32 practitioners, Prof Nienhaus recommended an annual screen of HCW at high-risk due to contact with highly-infectious patients. However, screening guidelines issued by the public health systems of different countries suggest a varied combination of X-ray, tuberculin skin test (TST) and interferon-g release assays (IGRA) with no consensus on the best strategy.…”

Regular Sputum Check-Up for Early Diagnosis of Tuberculosis after Exposure in Healthcare Facilities

“…Tuberculosis (TB) spread within a healthcare facility is a major public health problem worldwide [ 1 ]. The early identification of cases after TB exposure plays a pivotal role in preventing further transmission of Mycobacterium tuberculosis [ 2 , 3 ]. Healthcare facilities, including facilities caring for subjects with mental illness and facilities with limited personal space, such as prisons and military camps, are characterized by an enclosed environment which leads to the inevitable close and long duration of contact between participants.…”