title: Implementation and evaluation of an algorithm for isolation of patients with suspected pulmonary tuberculosis.
abstract: OBJECTIVE
  To implement and evaluate an algorithm designed to assist in the consistent placement of patients with suspected pulmonary tuberculosis into negative-pressure isolation rooms (NPIRs).
  
  
  METHODS
  A standard algorithm was designed for the appropriate room placement of patients with suspected pulmonary tuberculosis using clinical, radiographic, and laboratory criteria and reported risk factors. A case-patient was defined as an inpatient who had at least one Mycobacterium tuberculosis culture-positive respiratory specimen from January 1, 1993, through December 31, 1994. Demographic, clinical, laboratory, case contact, and isolation and room placement data were collected prospectively on all case patients.
  
  
  METHODS
  A 900-bed university teaching and referral center.
  
  
  RESULTS
  During 1993 and 1994, 69 patients were evaluated for possible pulmonary tuberculosis, and 31 case-patients were identified. Of the 31 case-patients, 26 (84%) were placed on respiratory isolation in NPIRs, including 19 (61%) who were isolated within 24 hours of admission (1993, 14 of 20 [70%]; 1994, 5 of 11 [45%]). Seven case-patients (23%) were isolated in NPIRs following delays that ranged from 2 to 31 days (median, 9 days), and five case-patients (16%) never were isolated during admissions of from 3 to 28 days (median, 4 days). These 12 case-patients contributed a total of 136 patient-exposure days during their hospitalizations. Misclassification of patient risk status by user error delayed isolation of five (42%) of the 12 improperly isolated case-patients.
  
  
  CONCLUSIONS
  The use of an algorithm incorporating radiographic, laboratory, and clinical criteria and reported risk factors may assist in the rapid isolation of patients with suspected pulmonary tuberculosis.
authors.affiliation: Infection Control Unit, Massachusetts General Hospital, Boston 02114, USA.
authors.forename: C F
authors.initials: CF
authors.lastname: Pegues
authors.forename: D C
authors.initials: DC
authors.lastname: Johnson
authors.forename: D A
authors.initials: DA
authors.lastname: Pegues
authors.forename: M
authors.initials: M
authors.lastname: Spencer
authors.forename: C C
authors.initials: CC
authors.lastname: Hopkins
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D015982:Bias; D003428:Cross Infection / Q000175:diagnosis / Q000517:prevention & control*; D003663:Decision Trees; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010356:Patient Isolation; D018579:Patient Selection; D016730:Program Development; D015397:Program Evaluation; D011446:Prospective Studies; D012307:Risk Factors; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000517:prevention & control*