INFECTION PREVENTION
people travel.” She highlighted the fact that the UK recruits healthcare workers from areas where there is a high incidence of TB and people are also moving from these countries looking for a better life. Refugees may also be living in dangerous conditions where the spread of TB is easier. “TB is still a significant cause of disease
and mortality…there are outbreak-provoking factors at large, despite all the excellent work going on – there are vulnerable people living in dangerous conditions, a lot of movement, increasing drug resistance and an absence of universal healthcare access.” She highlighted the fact that TB is not ‘a disease of the poor and undernourished, living in cramped conditions’ or ‘a disease of people with hazardous lifestyles’, but is, in fact, ‘an egalitarian disease’. Famous people who have died of TB include Kings and Queens, Eleanor Roosevelt and George Orwell – demonstrating that, if incidence is large enough, it spreads to us all. “There is no protection just because we are healthy,” she said. “It is important that we still treat it with the ‘respect’ it deserves.” Dr Curran went on to respond to the belief that TB is ‘not a nosocomial disease’, pointing out that transmission can be from patient to patient, patient to healthcare worker or from healthcare worker to patient. The WHO acknowledges that there needs to be recommendations to tackle the transmission of TB in healthcare and other congregate settings.
“It happens, it is real, it might not be happening at your hospital, but it is likely that it could do. Any institution, where there is shared living, can promote an outbreak...TB is an airborne disease and we all need to breathe. There have been outbreaks in hospitals, prisons, navy ships, long-term care facilities and schools. I think it is safe to say that it is present in refugee centres and it may be coming into the UK.” Figures from PHE’s report on TB in the UK (2015)1
increased risk of contracting TB, commented that there were ‘only’ 10 nosocomial transmissions involving healthcare workers identified between 2010 and 2012 and ‘only’ two involved transmission to patients. “Some people may be reassured by this, but I am not,” said Dr Curran. “I do not think low level nosocomial TB is acceptable. What part of the Health and Safety at Work act makes it ok not to protect yourself?” she commented.
indicated that 6.9% (300) were healthcare workers and Dr Curran pointed out that, in the past, TB has proved to be a nosocomial infection. Historical records for entrance testing of student nurses, in 1928, revealed that 185 were negative on entry and 152 were found to be positive – two years later 95% tested positive. Around 20% developed clinical disease. “I am aware of one city where three pathologists have been treated for TB. If it is more common in the population, it will become more common in healthcare workers and we need to be ready for that,” she warned.
A paper by Davidson et al (2016)3 , which looked at whether healthcare workers are at
She warned that we cannot afford to ‘take our foot off the pedal’ when it comes to TB control, as the outbreak of multi-drug resistant TB at a hospital in New York demonstrated, from January 1991-July 1992. Of the 32 patients with multi-drug- resistant TB, 28 (38%) had documented exposure to an infectious multi-drug-resistant TB patient while in hospital 30 days or more before being diagnosed. Isolates from 18 patients studied with restriction fragment length polymorphism analysis had the same DNA pattern, suggesting transmission of a common strain.4
In South Africa, workplace-acquired TB is one of the common occupational diseases reported among healthcare workers. The increased number of patients with HIV- related TB has increased workplace exposure and various studies have highlighted concerns at the high incidence of TB in healthcare workers. A study by Naidoo et al (2006),5
for
example, looked at incidence at eight public sector hospitals in the Ethekwini
The risks posed by the current migrant crisis makes multi-drug resistant tuberculosis an important and urgent public health priority.
28 I
WWW.CLINICALSERVICESJOURNAL.COM
municipality, KwaZulu-Natal, South Africa, using a retrospective record review for the period January 1999 to June 2004. Five hundred and eighty three healthcare workers were diagnosed with TB. The mean incidence of TB among healthcare workers for the study period was 1133.0 per 100000. Clinical presentation of TB included pulmonary TB (76.5%) and multi- drug resistant TB (3%).5
Cure was achieved
in 22.2% of healthcare workers and 40.7% completed their treatment. The authors concluded that the incidence of TB in healthcare workers is “alarmingly high”, and commented that the poor treatment outcomes were a cause for concern.5 Ghandi et al (2013) also reported on nosocomial transmission of extensively drug-resistant tuberculosis in a South African hospital, highlighting the fact that poor infection control, delayed diagnosis, and a high HIV prevalence facilitated transmission.6 One issue in hospitals has been an erroneous assumption among healthcare workers of safety, said Dr Curran. Because healthcare workers are looking after patients with TB for so long, they get used to the idea of it not being a risk. They feel they are immune, she commented. There are currently campaigns in South Africa to improve prevention and protection among healthcare workers. But Dr Curran pointed out that the potential for nosocomial outbreaks also exists in the UK. “We cannot base infection control precautions on the here and now… Given that the world is on the move, we may be exposing ourselves and other patients to TB unless we get our ‘ducks in a row’,” Dr Curran commented. She called for better guidance and audit of TB in healthcare settings. “It is not always, it is not often, but it is unacceptable,” she concluded.
FEBRUARY 2017
© stockdevil - Fotolia/Adobe Stock.
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64
