Lee Inhan, Kang Soyoung, Chin Bumsik, Joh Joon-Sung, Jeong Ina, Kim Junghyun, Kim Joohae, Lee Ji Yeon
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Medical Center, Seoul 04564, Republic of Korea.
Department of Infection Control and Prevention, National Medical Center, Seoul 04564, Republic of Korea.
J Clin Med. 2023 Feb 8;12(4):1361. doi: 10.3390/jcm12041361.
Delayed isolation of tuberculosis (TB) can cause unexpected exposure of healthcare workers (HCWs). This study identified the predictive factors and clinical impact of delayed isolation. We retrospectively reviewed the electronic medical records of index patients and HCWs who underwent contact investigation after TB exposure during hospitalization at the National Medical Center, between January 2018 and July 2021. Among the 25 index patients, 23 (92.0%) were diagnosed with TB based on the molecular assay, and 18 (72.0%) had a negative acid-fast bacilli smear. Sixteen (64.0%) patients were hospitalized via the emergency room, and 18 (72.0%) were admitted to a non-pulmonology/infectious disease department. According to the patterns of delayed isolation, patients were classified into five categories. Among 157 close-contact events in 125 HCWs, 75 (47.8%) occurred in Category A. Twenty-five (20%) HCWs had multiple TB exposures ( = 57 events), of whom 37 (64.9%) belonged to Category A (missed during emergency situations). After contact tracing, latent TB infection was diagnosed in one (1.2%) HCW in Category A, who was exposed during intubation. Delayed isolation and TB exposure mostly occurred during pre-admission in emergency situations. Effective TB screening and infection control are necessary to protect HCWs, especially those who routinely contact new patients in high-risk departments.
肺结核（TB）的延迟隔离会导致医护人员意外暴露。本研究确定了延迟隔离的预测因素和临床影响。我们回顾性分析了2018年1月至2021年7月期间在国家医疗中心住院期间接触结核病后接受接触者调查的索引患者和医护人员的电子病历。在25例索引患者中，23例（92.0%）通过分子检测被诊断为结核病，18例（72.0%）抗酸杆菌涂片阴性。16例（64.0%）患者通过急诊室入院，18例（72.0%）入住非肺病/传染病科室。根据延迟隔离模式，患者分为五类。在125名医护人员的157次密切接触事件中，75次（47.8%）发生在A类。25名（20%）医护人员有多次结核病接触（=57次事件），其中37次（64.9%）属于A类（在紧急情况下漏诊）。接触者追踪后，A类中有1名（1.2%）医护人员被诊断为潜伏性结核感染，该医护人员在插管期间接触过结核病。延迟隔离和结核病暴露大多发生在紧急情况下的入院前。有效的结核病筛查和感染控制对于保护医护人员是必要的，尤其是那些在高风险科室经常接触新患者的医护人员。
