Oral Presentations - Pathology and Laboratory Medicine - University ...

ResidentAbstract # 43Amanda Wilmer 1,2 , Elizabeth Bryce 1,2 , Jennifer Grant 1,21Department of Medicine, University of British Columbia, 2 Department of Microbiology,Vancouver General HospitalAmanda Wilmeris the third afb smear necessary to remove patientsfrom respiratory isolationBackround/ObjectivesRecent studies have suggested that two negative AFB smears may be as effective as three when screening patients forrespiratory isolation purposes for M. tuberculosis (MTB). However, current recommendations in Canada, the UnitedStates, and Europe still support a three-smear approach.MethodsThe microbiology database of a tertiary care hospital was searched for sputum, tracheal aspirates and bronchoscopysamples from 2003-2007 that had been sent for mycobacterial testing. The first patient specimen to become AFBsmear positive was noted. As well, the time required to collect the third specimen in hospitalized patients whoremained smear negative was used to estimate the savings in isolation costs associated with a two-smear approach.ResultsThere were 8347 respiratory specimens from 5168 patients in the five-year period. Of these patients, 2.2% (116/5168)were AFB smear positive, of whom 55.2% (64/116) were culture positive for MTB. Overall 89% (57/64) of patientswere identified as being AFB smear positive by the first smear, 7.8% (5/64) were identified by the second smear and3.2% (2/64) were identified by the third or greater smear. Smear negative patients spent 710 isolation days awaitingcollection of the third sample at a cost of approximately CA$142,000 over five years.ConclusionA two-smear approach for discontinuation of respiratory isolation precautions is a safe and cost effective.54 2 0 1 0 * P o s t e r P r e s e n t a t i o n s