Failure to implement respiratory isolation: why does it happen?
BACKGROUND
Respiratory isolation for 90% of individuals with acid-fast bacillus (AFB)-smear-positive tuberculosis (TB) is a recommended performance indicator in recent Infectious Diseases Society of America and Centers for Disease Control and Prevention guidelines. However, compliance with respiratory isolation reported from multiple centers in the United States and Europe falls short of that goal.


OBJECTIVE
To identify missed clues in TB patients who are not appropriately isolated.


METHODS
Retrospective survey.


METHODS
A 900-bed voluntary hospital.


METHODS
All patients with AFB-smear-positive TB admitted between January 1995 and December 1999 who were not appropriately isolated.


RESULTS
There were 173 TB cases admitted, including 106 with pulmonary TB. AFB smears were positive in 82 cases; 24 (29%) of these were not appropriately isolated. During the study period, the number of TB cases declined, but the proportion of appropriately isolated patients did not change. Most isolation failure cases were men (median age, 45.5 years); 21 of these patients were black, 2 were Hispanic white, and 1 was Asian, but none was non-Hispanic white. All isolation failure cases had at least one characteristic predictive of TB that could have been elicited at admission (eg, abnormal chest radiograph findings consistent with TB, fever, weight loss, a history of TB, a positive result on tuberculin skin test, hemoptysis, and human immunodeficiency virus infection).


CONCLUSIONS
Consistent with experiences at other hospitals, we found that the rate of isolation failure remained unchanged despite an overall decline in TB cases. In our experience, almost all isolation failures could be avoided by careful review of the history, physical examination, and chest radiograph for characteristics classically considered predictive of TB.
Iwata
Kentaro
K
Department of Medicine, St Luke's-Roosevelt Hospital Center, College of Physicians & Surgeons, Columbia University, New York, New York 10025, USA.
Smith
Barbara A
BA
Santos
Eloisa
E
Polsky
Bruce
B
Sordillo
Emilia M
EM
D000328:Adult; D000368:Aged; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D005260:Female; D019983:Guideline Adherence; D006746:Hospital Bed Capacity, 500 and over; D006788:Hospitals, Voluntary / Q000592:standards*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D010356:Patient Isolation / Q000592:standards / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D014376:Tuberculosis / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission