title: Prevalence and predictors of compliance with discontinuation of airborne isolation in patients with suspected pulmonary tuberculosis.
abstract: OBJECTIVE
  Examine the use of airborne isolation by identifying reasons for nontimely discontinuation and predictors of compliance with Centers for Disease Control and Prevention (CDC) guidelines. Compliance with guidelines should result in timely (within 48 hours) discontinuation of isolation in patients without infectious pulmonary tuberculosis (TB).
  
  
  METHODS
  Retrospective, observational study.
  
  
  METHODS
  A private, university-affiliated, tertiary-care medical center.
  
  
  METHODS
  All patients in airborne isolation for suspected pulmonary TB from June through December 2011.
  
  
  METHODS
  Chart reviews were performed to identify airborne isolation practices and delayed (greater than 48 hours) or very delayed (greater than 72 hours) discontinuation. We used descriptive statistics and logistic regression to determine independent predictors of nontimely discontinuation of isolation.
  
  
  RESULTS
  We identified 113 patients (mean age ± standard deviation, [Formula: see text] years; male sex, 75.2%; white race, 15.9%; mean collection interval ± standard deviation, [Formula: see text] hours). Delayed and very delayed isolation discontinuation was noted in 81% and 49% of patients, respectively. No significant differences in demographic characteristics and clinical characteristics were identified between groups. Predictors of timely (within 48 hours) airborne isolation discontinuation included use of alternate diagnosis for discontinuation of isolation ([Formula: see text]), early infectious diseases (ID) consultation ([Formula: see text]), pulmonary consultation ([Formula: see text]), average sputum collection interval less than 24 hours ([Formula: see text]), and need for more than 1 induced sputum specimen ([Formula: see text]). Adjusting for potential confounders, pulmonary consultation (odds ratio [OR] [95% confidence interval (CI)], 0.14 [0.03-0.58]), alternate diagnosis for discontinuation of isolation (OR [95% CI], 4.5 [1.3-15.8]), and early ID consultation (OR [95% CI], 4.0 [1.1-14.8]) were independently associated with timely discontinuation.
  
  
  CONCLUSIONS
  Timely airborne isolation discontinuation occurs in only 18.6% of cases and is an opportunity for cost savings, improved efficiency, and potentially patient safety and satisfaction.
authors.affiliation: Division of Infectious Diseases, Washington University School of Medicine, Saint Louis, Missouri, USA. bthomas@dom.wustl.edu
authors.forename: Benjamin S
authors.initials: BS
authors.lastname: Thomas
authors.forename: Erlaine F
authors.initials: EF
authors.lastname: Bello
authors.forename: Todd B
authors.initials: TB
authors.lastname: Seto
mesh_terms: D003428:Cross Infection / Q000517:prevention & control*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006254:Hawaii; D006801:Humans; D008297:Male; D008875:Middle Aged; D010356:Patient Isolation / Q000592:standards / Q000706:statistics & numerical data*; D015995:Prevalence; D012189:Retrospective Studies; D013183:Sputum / Q000382:microbiology; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000517:prevention & control*
references.citation: J Formos Med Assoc. 2007 Dec;106(12):1007-12
references.pmid: 18194906
references.citation: MMWR Morb Mortal Wkly Rep. 2011 Mar 25;60(11):333-7
references.pmid: 21430636
references.citation: JAMA. 2003 Oct 8;290(14):1899-905
references.pmid: 14532319
references.citation: J Hosp Med. 2012 May-Jun;7(5):365-9
references.pmid: 22315151
references.citation: J Infect. 1988 Jul;17(1):43-7
references.pmid: 3204269
references.citation: MMWR Recomm Rep. 2005 Dec 30;54(RR-17):1-141
references.pmid: 16382216
references.citation: Am J Respir Crit Care Med. 2002 Apr 1;165(7):927-33
references.pmid: 11934716
references.citation: Am J Infect Control. 2003 Oct;31(6):354-6
references.pmid: 14608302
references.citation: J Formos Med Assoc. 2009 Mar;108(3):202-9
references.pmid: 19293035
references.citation: J Formos Med Assoc. 2010 Apr;109(4):269-77
references.pmid: 20434036
references.citation: Infect Control Hosp Epidemiol. 2008 Mar;29(3):275-8
references.pmid: 18205528
references.citation: Chest. 2005 Jan;127(1):205-12
references.pmid: 15653985
references.citation: South Med J. 2003 Feb;96(2):141-5
references.pmid: 12630637
references.citation: Lancet. 1999 Oct 2;354(9185):1177-8
references.pmid: 10513715
references.citation: Am J Med. 2010 Jul;123(7):631-7
references.pmid: 20493464
references.citation: Am J Emerg Med. 2008 Oct;26(8):888-92
references.pmid: 18926346
references.citation: Int J Nurs Pract. 1998 Jun;4(2):84-96
references.pmid: 9748937
references.citation: J Hosp Infect. 2010 Oct;76(2):97-102
references.pmid: 20619929