Evaluation of tuberculosis Infection control Strategies at the Philippine General Hospital

Abstract

Background. Nosocomial TB transmission adversely affects inpatents and healthcare workers (HCWs). HCWs have a higher risk of tuberculosis and MDR-TB compared to the general populaton. Nosocomial TB outbreaks have occurred among patents with HIV/AIDS. Hospitals need to examine TB infecton control measures in order to address this growing concern. Objectve. This study aimed to evaluate the TB infecton control strategies in the adult service wards of the Philippine General Hospital (PGH). Methods. This descriptve study was conducted on adult inpatents with bacteriologically-confirmed PTB admited in April-August 2016. A data collecton tool based on Center for Disease Control (CDC) guidelines was utlized for chart review. Baseline characteristcs, diagnosis, treatment, and isolaton intervals were obtained and compared between areas. In-hospital TB infecton control practces were reviewed using the CDC TB Risk Assessment Worksheet with data from the TB-DOTS, UP Health Service, PGH Hospital Infecton Control Unit, and PGH Department of Laboratories. Results. Of the 95 patents with bacteriologically-confirmed PTB, data from 72 medical records were available and included in the analysis. Majority were Medicine patents (55.6%) with a diagnosis of pneumonia (52.8%). Only 61.1% were PTB suspects on admission. The mean diagnosis interval was 5.82 days±5.473, the mean treatment interval was 0.77 days±2.941, and the mean isolaton interval was 8.23 days±6.372. Only 41.7% were successfully isolated. The most common reasons for isolaton failure/delay were lack of vacancy (ER, Medicine wards) and lack of isolaton room (Surgical wards). Treatment initaton rate was 66.7% while TB-DOTS inpatent referral rate was 55.6%. The hospital is classified as having potental ongoing transmission of PTB. Conclusion. In this study, TB treatment was promptly started but there were delays in diagnosis and isolaton. Gaps included 1) lack of recogniton of a PTB case, 2) limited isolaton rooms, and 3) inadequate utlizaton of TB-DOTS. TB infecton control measures need to be strengthened in order to prevent nosocomial transmission of PTB.