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Utilization of Electronic Health Record Events to Conduct a Tuberculosis Contact Investigation in a High-Risk Oncology Unit

Published online by Cambridge University Press:  10 August 2017

Shauna C. Usiak
Affiliation:
Department of Medicine, Division of Infection Control, Memorial Sloan Kettering Cancer Center, New York, New York
Fabian A. Romero*
Affiliation:
Department of Medicine, Division of Infection Control, Memorial Sloan Kettering Cancer Center, New York, New York
Patrice Schwegman
Affiliation:
Health Informatics Department, Memorial Sloan Kettering Cancer Center, New York, New York
Violet Fitzpatrick
Affiliation:
Employee Health & Wellness Services, Memorial Sloan Kettering Cancer Center, New York, New York
MaryAnn Connor
Affiliation:
Department of Nursing, Nursing Informatics Division, Memorial Sloan Kettering Cancer Center, New York, New York
Janet Eagan
Affiliation:
Department of Medicine, Division of Infection Control, Memorial Sloan Kettering Cancer Center, New York, New York
Arthur E. Brown
Affiliation:
Employee Health & Wellness Services, Memorial Sloan Kettering Cancer Center, New York, New York
Mini Kamboj
Affiliation:
Department of Medicine, Division of Infection Control, Memorial Sloan Kettering Cancer Center, New York, New York
*
Address correspondence to Fabian A. Romero, 4922 Lasalle Rd, Hyattsville, MD, 20782 (romero.fabian.md@gmail.com).

Abstract

OBJECTIVE

To describe the utilization of electronic medical data resources, including health records and nursing scheduling resources, to conduct a tuberculosis (TB) exposure investigation in a high-risk oncology unit.

SETTING

A 42-bed inpatient unit with a mix of surgical and medical patients at a large tertiary-care cancer center in New York City.

PARTICIPANTS

High-risk subjects and coworkers exposed to a healthcare worker (HCW) with cavitary smear positive lung TB.

RESULTS

During the 3-month exposure period, 270 patients were admitted to the unit; 137 of these (50.7%) received direct care from the index case HCW. Host immune status and intensity of exposure were used to establish criteria for postexposure testing, and 63 patients (45%) met these criteria for first-tier postexposure testing. No cases of active TB occurred. Among coworkers, 146 had significant exposure (ie, >8 hours cumulative). In the 22-month follow-up period after the exposure, no purified protein derivative or interferon gamma release assay conversions or active cases of TB occurred among exposed HCWs or patients.

CONCLUSIONS

Electronic medical records and employee scheduling systems are useful resources to conduct otherwise labor-intensive contact investigations. Despite the high-risk features of our index case, a highly vulnerable immunocompromised patient population, and extended proximity to coworkers, we did not find any evidence of transmission of active or latent tuberculosis infection among exposed individuals.

Infect Control Hosp Epidemiol 2017;38:1235–1239

Type
Original Articles
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

a

Authors with equal contribution.

References

REFERENCES

1. Devadatta, S, Bhatia, AL, Andrews, RH, et al. Response of patients infected with isoniazid-resistant tubercle bacilli to treatment with isoniazid plus PAS or isoniazid alone. Bull World Health Organ 1961;25:807829.Google ScholarPubMed
2. Ramakrishnan, CV, Andrews, RH, Devadatta, S, et al. Prevalence and early attack rate of tuberculosis among close family contacts of tuberculous patients in South India under domiciliary treatment with isoniazid plus PAS or isoniazid alone. Bull World Health Organ 1961;26:361407.Google ScholarPubMed
3. Harris, TG, Sullivan Meissner, J, Proops, D. Delay in diagnosis leading to nosocomial transmission of tuberculosis at a New York City health care facility. Am J Infect Control 2013;41:155160.CrossRefGoogle Scholar
4. Malone, JL, Ijaz, K, Lambert, L, et al. Investigation of healthcare-associated transmission of Mycobacterium tuberculosis among patients with malignancies at three hospitals and at a residential facility. Cancer 2004;101:27132721.CrossRefGoogle Scholar
5. Greenaway, C, Menzies, D, Fanning, A, et al. Delay in diagnosis among hospitalized patients with active tuberculosis—predictors and outcomes. Am J Respir Crit Care Med 2002;165:927933.CrossRefGoogle ScholarPubMed
6. Jensen, PA, Lambert, LA, Iademarco, MF, Ridzon, R. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care settings, 2005. MMWR Recomm Rep 2005;54:1141.Google ScholarPubMed
7. Bureau of Tuberculosis Control Annual Summary. 2014. New York City Department of Health and Mental Hygiene website. https://www1.nyc.gov/assets/doh/downloads/pdf/tb/tb2014.pdf. Published 2015. Accessed July 14, 2017.Google Scholar
8. Driver, CR, Stricof, RL, Granville, K, et al. Tuberculosis in health care workers during declining tuberculosis incidence in New York State. Am J Infect Control 2005;33:519526.CrossRefGoogle ScholarPubMed
9. Nivin, B, Nicholas, P, Gayer, M, Frieden, TR, Fujiwara, PI. A continuing outbreak of multidrug-resistant tuberculosis, with transmission in a hospital nursery. Clin Infect Dis 1998;26:303307.CrossRefGoogle Scholar
10. Rogers, EF. Epidemiology of an outbreak of tuberculosis among school children. Public Health Rept 1962;77:401409.Google ScholarPubMed
11. Sepkowitz, KA. How contagious is tuberculosis? Clin Infect Dis 1996;23:954962.CrossRefGoogle ScholarPubMed
12. Yates, TA, Khan, PY, Knight, GM, et al. The transmission of Mycobacterium tuberculosis in high burden settings. Lancet Infect Dis 2016;16:227238.CrossRefGoogle ScholarPubMed
13. Kim, HR, Hwang, SS, Ro, YK, et al. Solid-organ malignancy as a risk factor for tuberculosis. Respirology 2008;13:413419.CrossRefGoogle ScholarPubMed
14. Kamboj, M, Sepkowitz, KA. The risk of tuberculosis in patients with cancer. Clin Infect Dis 2006;42:15921595.CrossRefGoogle ScholarPubMed
15. Kaplan, MH, Armstrong, D, Rosen, P. Tuberculosis complicating neoplastic disease. A review of 201 cases. Cancer 1974;33:850858.3.0.CO;2-H>CrossRefGoogle ScholarPubMed
16. Richeldi, L, Losi, M, D’Amico, R, et al. Performance of tests for latent tuberculosis in different groups of immunocompromised patients. Chest 2009;136:198204.CrossRefGoogle ScholarPubMed
17. Redelman-Sidi, G, Sepkowitz, KA. IFN-gamma release assays in the diagnosis of latent tuberculosis infection among immunocompromised adults. Am J Respir Crit Care Med 2013;188:422431.CrossRefGoogle Scholar
18. Arguello-Perez, E EC, Schneider, WJ, Del Castillo, MC, et al. Latent tuberculosis infection (LTBI) among healthcare workers (HCWs): 10 years of experience at Memorial Sloan Kettering Cancer Center (MSK). Infectious Disease Week (ID Week), San Diego, CA, October 7–11, 2015; poster 329.Google Scholar
19. National Tuberculosis Controllers A, Centers for Disease C, Prevention. Guidelines for the investigation of contacts of persons with infectious tuberculosis. Recommendations from the National Tuberculosis Controllers Association and CDC. MMWR Recomm Rep 2005;54:147.Google ScholarPubMed
20. Tuberculosis and air travel. Guidelines for prevention and control. Third Edition. WHO. http://www.who.int/tb/publications/2008/WHO_HTM_TB_2008.399_eng.pdf. Published 2008. Accessed February 4, 2017.Google Scholar
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