Nosocomial tuberculosis risk assessment and management recommendation for an emergency department in a university hospital.
OBJECTIVE
To assess the nosocomial TB risk and recommend appropriate risk management procedure for the trauma ward of the emergency department at a university hospital in Bangkok.


METHODS
The risk assessment procedure includes: (1) estimating the number of healthcare visits of the TB patients at the trauma ward of emergency department in 2004; (2) determining the TB incidence rate among the healthcare workers (HCWs) of the trauma ward during 2004-2005; and (3) surveying the indoor environment (particularly concerning the ventilation condition) of the targeting ward. Appropriate risk management procedures were then recommended based on the guidelines provided by The World Health Organization (WHO) and The Centers for Disease Control and Prevention (CDC) of the United States.


RESULTS
The estimated number of healthcare visits of the TB patient at the trauma ward in 2004 was 20. During 2004-2005, there were 4 out of 57 HCWs at the trauma ward who developed tuberculosis; among these were two registered nurses and two nursing auxiliaries. The TB incidence rates among these HCWs were 3,509 per 100,000 person-year overall (or 2,632 per 100, 000 person-year for confirmed TB cases only) and 3,333 (or 1,667 for confirmed TB cases only) and 4,761 per 100, 000 person-year for registered nurse and nursing auxiliary. The ventilation in the trauma inpatient ward had 1.43 air changes per hour, which was below the recommended standard value. Turbulence pattern of airflow, which promotes airborne TB spreading in this area, was also detected.


CONCLUSIONS
The risk assessment results showed that the trauma ward of the emergency department at this university hospital has a high risk for nosocomial tuberculosis. Appropriate risk management procedures, which are in accord with the standard guidelines, should be urgently implemented.
Jiamjarasrangsi
Wiroj
W
Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.
Urith
Sarawuth
S
Srisintorn
Wisaruth
W
D000328:Adult; D003428:Cross Infection / Q000517:prevention & control*; D004636:Emergency Service, Hospital; D004780:Environment, Controlled; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D018570:Risk Assessment; D012308:Risk Management; D013785:Thailand; D014376:Tuberculosis / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission