title: Delayed suspicion, treatment and isolation of tuberculosis patients in pulmonology/infectious diseases and non-pulmonology/infectious diseases wards.
abstract: OBJECTIVE
  Delayed diagnosis and isolation increases the risk of nosocomial transmission of tuberculosis (TB). To assess the risk of delayed management of TB, we analyzed the risk factors of prolonged delay in isolation of smear-positive TB patients in pulmonology/infectious diseases and other wards in a tertiary teaching hospital.
  
  
  METHODS
  We enrolled smear-positive TB patients aged > 16 years with delayed respiratory isolation following hospitalization. Medical records were reviewed retrospectively. Time intervals between admission, order of sputum acid-fast staining, initiation of anti-tuberculous treatment and isolation were compared between pulmonology/infectious diseases wards (PIWs) and other wards. Risk factors were analyzed in patients with prolonged isolation delay of > 7 days in individual groups.
  
  
  RESULTS
  Isolation was delayed in 191 (73.7%) of 259 hospitalized smear-positive TB patients. Median suspicion, treatment and isolation delays were 0, 3 and 4 days in PIWs and 1, 5 and 7 days in other wards. For patients admitted to non-PIWs, atypical chest radiographs, symptoms without dyspnea or not being admitted from the emergency department (ED) were risk factors for prolonged isolation delay exceeding 7 days. The only risk factor for delayed isolation in patients admitted to PIWs was age >or= 70 years.
  
  
  CONCLUSIONS
  Delays in suspicion, treatment and isolation of TB patients were longer in non-PIWs. Clinicians should be alert to those admitted to non-PIWs with atypical chest radiographs, atypical symptoms, or not admitted from the ED.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Chang-Gung Memorial Hospital, Linkou, and Department of Respiratory Care, Chang-Gung University, Taiwan.
authors.forename: Meng-Jer
authors.initials: MJ
authors.lastname: Hsieh
authors.forename: Huey-Wen
authors.initials: HW
authors.lastname: Liang
authors.forename: Ping-Chern
authors.initials: PC
authors.lastname: Chiang
authors.forename: Te-Chih
authors.initials: TC
authors.lastname: Hsiung
authors.forename: Chung-Chi
authors.initials: CC
authors.lastname: Huang
authors.forename: Ning-Hung
authors.initials: NH
authors.lastname: Chen
authors.forename: Han-Chung
authors.initials: HC
authors.lastname: Hu
authors.forename: Ying-Huang
authors.initials: YH
authors.lastname: Tsai
mesh_terms: D000368:Aged; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010356:Patient Isolation / Q000706:statistics & numerical data*; D010362:Patients' Rooms / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy