title: Tuberculosis transmission risk and infection control in a hospital emergency department in Lima, Peru.
abstract: BACKGROUND
  Overcrowded emergency departments (EDs) are used by undiagnosed tuberculosis (TB) patients. TB infection control measures are seldom prioritized, making EDs potential foci of unrecognised nosocomial transmission.
  
  
  OBJECTIVE
  To quantify TB infection risk among health care workers in an ED in a high TB-burden setting, Lima, Peru, and to evaluate TB infection control measures.
  
  
  METHODS
  Consenting ED staff were tested for TB infection at baseline and after 1 year using the QuantiFERON-TB Gold In-Tube (QFT-G). In parallel, sputum for TB culture was requested from patients spending >2 h in the ED, irrespective of presenting complaint. Infection control measures were documented and room ventilation measured.
  
  
  RESULTS
  Over 1 year, there were 2246 TB patient-hours of exposure in the ED from 153 different patients. At baseline, 56% of the 70 staff recruited were QFT-G-positive; 27 of 31 baseline-negatives consented to follow-up after 1 year, and eight (30%, all clinical staff) tested positive. Annual incidence of infection was 1730 per 100,000 population. TB infection control measures were sub-optimal, with no patient screening, no isolation rooms, inadequate ventilation and sporadic respirator use.
  
  
  CONCLUSIONS
  ED staff were exposed to an unexpectedly large TB burden in the workplace, resulting in a high rate of TB infection. TB infection control should be prioritized in EDs, especially in high-prevalence settings.
authors.affiliation: Department of Infectious Diseases & Immunity and Wellcome Trust Centre for Clinical Tropical Medicine, Imperial College London, London, UK. rod.escombe@imperial.ac.uk
authors.forename: A R
authors.initials: AR
authors.lastname: Escombe
authors.forename: L
authors.initials: L
authors.lastname: Huaroto
authors.forename: E
authors.initials: E
authors.lastname: Ticona
authors.forename: M
authors.initials: M
authors.lastname: Burgos
authors.forename: I
authors.initials: I
authors.lastname: Sanchez
authors.forename: L
authors.initials: L
authors.lastname: Carrasco
authors.forename: E
authors.initials: E
authors.lastname: Farfán
authors.forename: F
authors.initials: F
authors.lastname: Flores
authors.forename: D A J
authors.initials: DA
authors.lastname: Moore
mesh_terms: D000328:Adult; D004636:Emergency Service, Hospital / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D006749:Hospital Design and Construction; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000517:prevention & control*; D008297:Male; D016273:Occupational Exposure / Q000517:prevention & control*; D010564:Personnel, Hospital; D010568:Peru / Q000453:epidemiology; D014376:Tuberculosis / Q000175:diagnosis / Q000517:prevention & control* / Q000635:transmission; D014691:Ventilation / Q000592:standards