ISRAEL SOCIETY OF PULMONARY MEDICINE ANNUAL ... - e-Med

Pulmonary Tuberculosis Outbreak in an Internal Medicine Ward in a University
Hospital in Central Israel.
Zohar Mor 1 , MD, MHA; Ziva Amitai 2 , MD, MPH; Gerald Baum 3 , MD;
Orly Roich 1 , MPH; Daniel Chemtob 1 , MD, MPH.
Introduction:
Mycobacterium tuberculosis is transmitted by droplets nuclei from infected patient to
terminal air passage of another person. Hospitalized pulmonary tuberculosis (PTB)
patients may spread the infection to other patients or to health care workers.
Internal medicine wards in general hospitals, which admit PTB patients, are expected
to implement infection control measures to protect other patients and staff, until the
PTB patient is transferred to a designated tuberculosis hospital.
Aim:
Ascertaining the risk of admitting PTB patient in general hospitals and the importance
of addressing infection control measures to protect hospitalized patients and staff.
Methods:
Describing epidemiologic investigation of tuberculosis outbreak among health care
workers in an internal medicine ward in a generalized hospital.
Results:
In October 2001, an HIV positive work immigrant from Nigeria was hospitalized in
an internal medicine ward and was further diagnosed as PTB patient. During the
following next 3 years, 5 health care workers were diagnosed with PTB.
Following a detection of each of these PTB cases, an epidemiologic investigation was
conducted. Using molecular biology, it was found that all of the PTB patients shared
an identical strain, demonstrating direct transmission. Additionally, 25 staff members
and 10 people previously hospitalized in that ward were diagnosed as having latent
tuberculosis infection.
Investigating team reported limited compliance of ward staff to performing tuberculin
skin tests, partial adherence with preventive tuberculosis therapy and paucity of
measures available for the employer to encourage health care workers to take
precautions in tuberculosis control.
The ward’s physical conditions did not allow appropriate isolation of airborne
communicable disease.
Conclusions:
The outbreak emphasizes the difficulties of treating PTB patient in internal wards and
highlights the challenges of tuberculosis control in hospital setting.
In order to control PTB in health care setting, it is important to comply with the
current guidelines: respiratory isolation of PTB patients until transfer to tuberculosis
designated hospital, prompt screening of health care workers upon employment and
periodically thereafter and adherence to preventive therapy regime in latent infections.
1- Department of TB and AIDS, Public Health Services, Ministry of Health.
2- Tel-Aviv health department, Public Health Services, Ministry of Health.
3- Tel-Aviv TB clinic, Israeli lung association, Tel-Aviv.
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