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Compliance with Postexposure Screening and Treatment of Latent Tuberculosis Infection among Healthcare Workers in a Tertiary Care Hospital in Saudi Arabia

Published online by Cambridge University Press:  10 May 2016

Hanan H. Balkhy ,
Thaddeus L. Miller ,
Saira Ali ,
Jennifer B. Nuzzo ,
Karine Kentenyants ,
Aiman El-Saed  and
Scott J. N. McNabb
Hanan H. Balkhy*
Affiliation:
Infection Prevention and Control Department, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
Thaddeus L. Miller
Affiliation:
School of Public Health, University of North Texas Health Sciences Center, Fort Worth, Texas
Saira Ali
Affiliation:
Infection Prevention and Control Department, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
Jennifer B. Nuzzo
Affiliation:
Center for Biosecurity, University of Pittsburgh Medical Center, Baltimore, Maryland
Karine Kentenyants
Affiliation:
Rollins School of Public Health, Emory University, Atlanta, Georgia
Aiman El-Saed
Affiliation:
Infection Prevention and Control Department, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia Community Medicine Department, Mansoura University, Daqahlia, Egypt
Scott J. N. McNabb
Affiliation:
Rollins School of Public Health, Emory University, Atlanta, Georgia
*
King Saud bin Abdulaziz University for Health Sciences, P.O. Box 22490, Riyadh 11426, Saudi Arabia (balkhyh@hotmail.com)
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Abstract

Background.

Controlling tuberculosis (TB) infection among occupationally exposed healthcare workers (HCWs) may be challenging.

Methods.

We retrospectively reviewed clinical records of HCWs who were exposed to patients diagnosed with infectious TB at King Abdulaziz Medical City, Riyadh, Saudi Arabia, between 2008 and 2010. The collected data included baseline tuberculin skin test (TST) status, potential predictors of TST positivity, postexposure diagnosis of latent TB infection (LTBI), and postexposure compliance with LTBI therapy.

Results.

Thirteen patients were diagnosed with infectious pulmonary TB during the study period. A total of 298 HCWs met our definition for exposure. Exposed HCWs tended to be female (62.9%), non-Saudi (83.9%), nurses (68.6%), or respiratory therapists (24.0%) working in critical care locations (72.8%). Baseline (preemployment) TST documentation existed for 41.3% (123/298). Among those with documented baseline TSTs, 51.2% (63/123) were positive, representing 21.1% (63/298) of all HCWs. Only 48.9% (115/235) of exposed HCWs who had negative or unknown preexposure TST status had their TST tested after exposure. Approximately 46.1% (53/115) of them were diagnosed with postexposure LTBI, and 92.5% (49/53) of them were prescribed LTBI therapy. Among those, 93.9% (46/49) started LTBI therapy; however, 82.6% (38/46) failed to complete the recommended course.

Conclusions.

We found low rates of baseline TST documentation and postexposure screening among exposed HCWs. Compliance with initiating postexposure isoniazid prophylaxis among HCWs was fair, but only a small fraction of those who started prophylaxis completed the recommended course of therapy. These findings suggest substantial opportunities to implement administrative measures to enhance LTBI management among HCWs.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 2 , February 2014 , pp. 176 - 181
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

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