Document Detail


Failure to implement respiratory isolation: why does it happen?
MedLine Citation:
PMID:  12400889     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Respiratory isolation for 90% of individuals with acid-fast bacillus (AFB)-smear-positive tuberculosis (TB) is a recommended performance indicator in recent Infectious Diseases Society of America and Centers for Disease Control and Prevention guidelines. However, compliance with respiratory isolation reported from multiple centers in the United States and Europe falls short of that goal. OBJECTIVE: To identify missed clues in TB patients who are not appropriately isolated. DESIGN: Retrospective survey. SETTING: A 900-bed voluntary hospital. PATIENTS: All patients with AFB-smear-positive TB admitted between January 1995 and December 1999 who were not appropriately isolated. RESULTS: There were 173 TB cases admitted, including 106 with pulmonary TB. AFB smears were positive in 82 cases; 24 (29%) of these were not appropriately isolated. During the study period, the number of TB cases declined, but the proportion of appropriately isolated patients did not change. Most isolation failure cases were men (median age, 45.5 years); 21 of these patients were black, 2 were Hispanic white, and 1 was Asian, but none was non-Hispanic white. All isolation failure cases had at least one characteristic predictive of TB that could have been elicited at admission (eg, abnormal chest radiograph findings consistent with TB, fever, weight loss, a history of TB, a positive result on tuberculin skin test, hemoptysis, and human immunodeficiency virus infection). CONCLUSION: Consistent with experiences at other hospitals, we found that the rate of isolation failure remained unchanged despite an overall decline in TB cases. In our experience, almost all isolation failures could be avoided by careful review of the history, physical examination, and chest radiograph for characteristics classically considered predictive of TB.
Authors:
Kentaro Iwata; Barbara A Smith; Eloisa Santos; Bruce Polsky; Emilia M Sordillo
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Infection control and hospital epidemiology : the official journal of the Society of Hospital Epidemiologists of America     Volume:  23     ISSN:  0899-823X     ISO Abbreviation:  Infect Control Hosp Epidemiol     Publication Date:  2002 Oct 
Date Detail:
Created Date:  2002-10-28     Completed Date:  2003-02-12     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8804099     Medline TA:  Infect Control Hosp Epidemiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  595-9     Citation Subset:  IM; N    
Affiliation:
Department of Medicine, St Luke's-Roosevelt Hospital Center, College of Physicians & Surgeons, Columbia University, New York, New York 10025, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Cross Infection / epidemiology,  prevention & control*,  transmission
Female
Guideline Adherence*
Hospital Bed Capacity, 500 and over
Hospitals, Voluntary / standards*
Humans
Incidence
Male
Middle Aged
New York City / epidemiology
Patient Isolation / standards,  utilization*
Quality Indicators, Health Care
Retrospective Studies
Tuberculosis / epidemiology,  prevention & control*,  transmission

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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