Tuberculosis transmission risk and infection control in a hospital emergency department in Lima, Peru

A. Rod Escombe, Luz Maria Huaroto Valdivia, Eduardo Romulo Ticona Chavez, M. Burgos, I. Sanchez, L. Carrasco, E. Farfán, F. Flores, D. A.J. Moore

Research output: Contribution to journalArticlepeer-review

44 Scopus citations

Abstract

BACKGROUND: Overcrowded emergency departments (EDs) are used by undiagnosed tuberculosis (TB) patients. TB infection control measures are seldom prioritised, making EDs potential foci of unrecognised nosocomial transmission. OBJECTIVE: To quantify TB infection risk among health care workers in an ED in a high TB-burden setting, Lima, Peru, and to evaluate TB infection control measures. METHODS: Consenting ED staff were tested for TB infection at baseline and after 1 year using the Quanti-FERON® -TB Gold In-Tube (QFT-G). In parallel, sputum for TB culture was requested from patients spending >2 h in the ED, irrespective of presenting complaint. Infection control measures were documented and room ventilation measured. RESULTS: Over 1 year, there were 2246 TB patient-hours of exposure in the ED from 153 different patients. At baseline, 56% of the 70 staff recruited were QFT-G-positive; 27 of 31 baseline-negatives consented to follow-up after 1 year, and eight (30%, all clinical staff) tested positive. Annual incidence of infection was 1730 per 100 000 population. TB infection control measures were sub-optimal, with no patient screening, no isolation rooms, inadequate ventilation and sporadic respirator use. CONCLUSIONS: ED staff were exposed to an unexpectedly large TB burden in the workplace, resulting in a high rate of TB infection. TB infection control should be prioritised in EDs, especially in high-prevalence settings.

Original languageEnglish
Pages (from-to)1120-1126
Number of pages7
JournalInternational Journal of Tuberculosis and Lung Disease
Volume14
Issue number9
StatePublished - Sep 2010
Externally publishedYes

Keywords

  • Infection control
  • Nosocomial transmission
  • Occupational tuberculosis
  • Tuberculosis

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