Latent tuberculosis infection in healthcare workers. A case-control study in a paediatric hospital

Abstract

According to the World Health Organisation (WHO), antibiotic misuse is a major threat to patient safety, putting everyone at risk via its contribution to antibiotic resistance. As part of WHO's Evidence-informed Policy Network, and with the strong technical, capacity building and financial assistance of both the WHO Regional Office for Europe and the WHO Country Office for Hungary, the country has prepared an evidence brief for policy (EBP) on this issue. The objective of the EBP was to summarize in a user-friendly way the best available evidence (systematic reviews, research articles, grey literature, data analysis, key informants and expert knowledge) to answer the following: How can the problem of antibiotic misuse in Hungary be described and interpreted? What evidence-informed policy options are available for addressing the problem? What are the main barriers to and enablers for the implementation of the different options? Based on the EBP, a policy dialogue (PD) took place in, involving a wide range of stakeholders to explore possibilities of implementation. The EBP concludes that the main problem is the overuse of certain broad-spectrum antibiotics. It proposes three policy options: developing a national antibiotic stewardship programme and guidelines on the diagnosis and treatment of common infections, strengthening medical education on prudent antibiotic prescribing, and. raising awareness of prudent antibiotic use through information campaigns, leaflets and interpersonal communication. Participants of the PD agreed with the main EBP findings. They highlighted the most important measures to facilitate implementation (including simple, easy-to-use guidelines, cross-disciplinary collaboration in hospitals, better medical education on prudent prescribing, raising public awareness through general practitioners, etc.). Projects such as steward-ship and guideline development, along with research on targeting information campaigns, have already been launched. Key messages: The problem of antibiotic misuse should be addressed at multiple levels. EBPs are successful tools in informing stakeholder dialogue and proposing viable options for implementation. Tuberculosis (TB) is a well-known occupational risk for health care workers (HCWs). Aim of the study was to evaluate Latent Tuberculosis Infection (LTBI) in HCWs of a paediatric hospital, Italian reference center for children affected by TB. Over the period 2007-2015 a case control study was carried out on 2,416 health care workers (HCWs) subjected to surveillance by the hospital Occupational Medicine Unit. HCWs were studied with the IGRA (Quanti-FERON-TB Gold In-Tube (QFT) screening test. Case and control subjects were selected between the hospital HCWs. Univariate and multivariate statistical analyses were performed by software IBM SPSS Statistics (version 20). Kappa statistics were used to evaluate the concordance between Tubercolin Skin (TST) and IGRA tests. From July 2007 to July 2015 a total of 2,416 HCWs underwent testing for IGRA. IGRA positive HCWs were 118 (4.9%) in at least one determination. A control group was selected (118 HCWs) in the same population with a negative IGRA test and the same general features of the cases subjects. At multivariable analysis being physicians (p = 0.04; OR 0.40 IC95% 0.08-0.94) and having had contacts with TB cases active in the workplace (p = 0.03; OR 0.39 IC95% 0.17-0.89) represent protective factors for LTBI (R2 = 0.40). None of the HCWs showed evidence of clinical disease. Low concordance was detected between TST and IGRA tests (k = 0.25). Our research shows that, in a low-incidence country, about 1 out of 20 HCWs was IGRA positive in a paediatric tertiary hospital. The main findings, although similar to several studies on LTBI in HCWs conducted in other hospitals of low-incidence countries, provide new information on a paediatric hospital with high risk of exposure. Further studies will be conducted comparing the present results with QuantiFERON-TB Gold Plus test, recently introduced in the hospital HCWs surveillance system. Key messages: Latent Tuberculosis infection shows a low incidence in a paediatric hospital at high risk of exposure. Properly respecting TB prevention procedures makes HCWs working conditions safer. Practice what you preach: measles vaccination coverage and outbreaks in healthcare workers in Europe