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Analysing Tuberculosis Cases Among Healthcare Workers to Inform Infection Control Policy and Practices

Published online by Cambridge University Press:  08 June 2017

Gerard de Vries ,
Rianne van Hunen ,
Fleur S. Meerstadt-Rombach ,
Paul D. L. P. M. van der Valk ,
Marinus Vermue  and
Sytze T. Keizer
Gerard de Vries*
Affiliation:
Team The Netherlands and Elimination, KNCV Tuberculosis Foundation, The Hague, The Netherlands Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
Rianne van Hunen
Affiliation:
Team The Netherlands and Elimination, KNCV Tuberculosis Foundation, The Hague, The Netherlands Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
Fleur S. Meerstadt-Rombach
Affiliation:
Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
Paul D. L. P. M. van der Valk
Affiliation:
Pulmonology Department, Medisch Spectrum Twente Hospital, Enschede, The Netherlands
Marinus Vermue
Affiliation:
Tuberculosis Control Department, Municipal Public Health Service Groningen, Groningen, The Netherlands
Sytze T. Keizer
Affiliation:
Tuberculosis Control Department, Public Health Service Amsterdam, Amsterdam, The Netherlands
*
Address correspondence to Gerard de Vries, MD, KNCV Tuberculosis Foundation, PO Box 146, 2501 CC Den Haag, The Netherlands (gerard.devries@kncvtbc.org).
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Abstract

OBJECTIVE

To determine the number and proportion of healthcare worker (HCW) tuberculosis (TB) cases infected while working in healthcare institutions in the Netherlands and to learn from circumstances that led to these infections.

DESIGN

Cohort analysis.

METHODS

We included all HCW TB patients reported to the Netherlands TB Register from 2000 to 2015. Using data from this register, including DNA fingerprints of the bacteria profile and additional information from public health clinics, HCW TB cases were classified into 4 categories: (1) infected during work in the Netherlands, (2) infected in the community, (3) infected outside the Netherlands, or (4) outside these 3 categories. An in-depth analysis of category 1 cases was performed to identify factors contributing to patient-to-HCW transmission.

RESULTS

In total, 131 HCW TB cases were identified: 32 cases (24%) in category 1; 13 cases (10%) in category 2; 42 cases (32%) in category 3; and 44 cases (34%) in category 4. The annual number of HCW TB cases (P<.05), the proportion among reported cases (P<.01), and the number of category 1 HCW TB cases (P=.12) all declined over the study period. Delayed diagnosis in a TB patient was the predominant underlying factor of nosocomial transmission in 47% of category 1 HCW TB patients, most of whom were subsequently identified in a contact investigation. Performing high-risk procedures was the main contributing factor in the other 53% of cases.

CONCLUSION

In low-incidence countries, every HCW TB case should warrant timely and thorough investigation to help further define and fine-tune the HCW screening policy and to monitor its proper implementation.

Infect Control Hosp Epidemiol 2017;38:976–982

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 8 , August 2017 , pp. 976 - 982
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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