Infectious Diseases Division, Program for Emerging Infections, icddr,b, Dhaka, Bangladesh.
School of Population Health, University of New South Wales, Sydney, Australia.
PLoS One. 2020 Dec 17;15(12):e0243951. doi: 10.1371/journal.pone.0243951. eCollection 2020.
In Bangladesh, there is currently no data on the burden of latent TB infection (LTBI) amongst hospital healthcare workers (HCWs). This study aimed to determine the prevalence of LTBI and compare the prevalence among HCWs in two public tertiary care hospitals. Between September 2018 and August 2019, we conducted a cross-sectional study in two public tertiary care general hospitals. Using a survey and tuberculin skin test (TST), we assessed risk factors for LTBI, adjusting for known and plausible confounders. In addition, a facility assessment was undertaken to understand the implementation of relevant IPC measures. The prevalence of LTBI among HCWs was 42%. HCWs spent a median of 6 hours (SD = 1.76, IQR 2.00) per day and attended an average of 1.87 pulmonary TB patients per week. HCWs did not receive any TB IPC training, the wards lacked a symptom checklist to screen patients for TB, and no masks were available for coughing patients. Seventy-seven percent reportedly did not use any facial protection (masks or respirators) while caring for patients. In the multivariable model adjusting for hospital level clustering effect, TST positivity was significantly higher among HCWs aged 35-45 years (aOR1.36, 95% CI: 1.06-1.73) and with >3 years of service (aOR 1.67, 95% CI: 1.62-1.72). HCWs working in the medicine ward had 3.65 (95% CI: 2.20-6.05) times, and HCWs in the gynecology and obstetrics ward had 2.46 (95% CI: 1.42-4.27) times higher odds of TST positivity compared to HCWs working in administrative areas. This study identified high prevalence of LTBI among HCWs. This may be due to the level of exposure to pulmonary TB patients, and/or limited use of personal protective equipment along with poor implementation of TB IPC in the hospitals. Considering the high prevalence of LTBI, we recommend the national TB program consider providing preventative therapy to the HCWs as the high-risk group, and implement TB IPC in the hospitals.
在孟加拉国，目前尚无医院医护人员（HCWs）潜伏性结核病感染（LTBI）负担的数据。本研究旨在确定 LTBI 的流行率，并比较两家公立三级保健医院 HCWs 之间的流行率。2018 年 9 月至 2019 年 8 月，我们在两家公立三级综合医院进行了横断面研究。我们使用问卷调查和结核菌素皮肤试验（TST）来评估 LTBI 的危险因素，并针对已知和合理的混杂因素进行了调整。此外，还进行了一次设施评估，以了解相关感染预防和控制措施的实施情况。HCWs 中 LTBI 的患病率为 42%。HCWs 每天平均工作 6 小时（SD=1.76，IQR 2.00），每周平均照顾 1.87 例肺结核患者。HCWs 没有接受任何结核病感染预防和控制培训，病房缺乏筛查结核病患者的症状检查表，也没有为咳嗽患者提供口罩。据报道，77%的医护人员在照顾患者时没有使用任何面部保护（口罩或呼吸器）。在调整医院水平聚类效应的多变量模型中，年龄在 35-45 岁的 HCWs（aOR1.36，95%CI：1.06-1.73）和服务年限超过 3 年的 HCWs（aOR 1.67，95%CI：1.62-1.72）的 TST 阳性率显著更高。与在行政区域工作的 HCWs 相比，在内科病房工作的 HCWs 的 TST 阳性率有 3.65 倍（95%CI：2.20-6.05），在妇产科病房工作的 HCWs 的 TST 阳性率有 2.46 倍（95%CI：1.42-4.27）。本研究发现 HCWs 中 LTBI 的患病率较高。这可能是由于与肺结核患者接触的程度，以及/或个人防护设备的使用有限，以及医院中结核病感染预防和控制措施的执行不力。鉴于 LTBI 的高患病率，我们建议国家结核病规划考虑为高危人群的 HCWs 提供预防性治疗，并在医院实施结核病感染预防和控制措施。
