Compliance with postexposure screening and treatment of latent tuberculosis infection among healthcare workers in a tertiary care hospital in Saudi Arabia.
BACKGROUND
Controlling tuberculosis (TB) infection among occupationally exposed healthcare workers (HCWs) may be challenging.


METHODS
We retrospectively reviewed clinical records of HCWs who were exposed to patients diagnosed with infectious TB at King Abdulaziz Medical City, Riyadh, Saudi Arabia, between 2008 and 2010. The collected data included baseline tuberculin skin test (TST) status, potential predictors of TST positivity, postexposure diagnosis of latent TB infection (LTBI), and postexposure compliance with LTBI therapy.


RESULTS
Thirteen patients were diagnosed with infectious pulmonary TB during the study period. A total of 298 HCWs met our definition for exposure. Exposed HCWs tended to be female (62.9%), non-Saudi (83.9%), nurses (68.6%), or respiratory therapists (24.0%) working in critical care locations (72.8%). Baseline (preemployment) TST documentation existed for 41.3% (123/298). Among those with documented baseline TSTs, 51.2% (63/123) were positive, representing 21.1% (63/298) of all HCWs. Only 48.9% (115/235) of exposed HCWs who had negative or unknown preexposure TST status had their TST tested after exposure. Approximately 46.1% (53/115) of them were diagnosed with postexposure LTBI, and 92.5% (49/53) of them were prescribed LTBI therapy. Among those, 93.9% (46/49) started LTBI therapy; however, 82.6% (38/46) failed to complete the recommended course.


CONCLUSIONS
We found low rates of baseline TST documentation and postexposure screening among exposed HCWs. Compliance with initiating postexposure isoniazid prophylaxis among HCWs was fair, but only a small fraction of those who started prophylaxis completed the recommended course of therapy. These findings suggest substantial opportunities to implement administrative measures to enhance LTBI management among HCWs.
Infection Prevention and Control Department, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Hanan H
HH
Balkhy
Thaddeus L
TL
Miller
Saira
S
Ali
Jennifer B
JB
Nuzzo
Karine
K
Kentenyants
Aiman
A
El-Saed
Scott J N
SJ
McNabb
D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D003428:Cross Infection / Q000175:diagnosis* / Q000188:drug therapy / Q000635:transmission; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000517:prevention & control / Q000706:statistics & numerical data*; D055985:Latent Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy / Q000635:transmission; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000517:prevention & control / Q000706:statistics & numerical data; D010564:Personnel, Hospital / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012529:Saudi Arabia / Q000453:epidemiology; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*; D014374:Tuberculin Test / Q000706:statistics & numerical data; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy / Q000635:transmission; D055815:Young Adult
D000995:Antitubercular Agents