title: Delayed tuberculosis diagnosis and costs of contact investigations for hospital exposure: New York City, 2010-2014.
abstract: BACKGROUND
  A delayed diagnosis of tuberculosis (TB) in the hospital may lead to nosocomial exposure, placing employees and other patients at risk. A lack of prompt infection control measures for suspected cases at the time of admission may require complicated and expensive contact investigations. The purpose of this study was to estimate the person-hour costs required by infection control staff to investigate a single hospital-based TB exposure.
  
  
  METHODS
  Electronic data were extracted from 2 tertiary hospitals and 1 community hospital in a large health care system in metropolitan New York City to identify pulmonary TB cases unsuspected at admission. All cases were reviewed by infection prevention and control (IPC) staff to identify exposures.
  
  
  RESULTS
  From 2010-2014, 34 pulmonary TB cases which necessitated a contact investigation were identified. IPC staff calculated an average of 15-20 hours of work per exposure plus 30 minutes of follow-up for each exposed staff member. For exposures, time from admission to isolation averaged 3.3 days, with a mean of 41 staff exposed per patient and an approximate resource usage of 38 person-hours.
  
  
  CONCLUSIONS
  Contact investigations are costly to the health care system. In a low-prevalence country, such as the United States, it is still important that health care providers are trained to think TB.
authors.affiliation: School of Nursing, Columbia University Medical Center, New York, NY. Electronic address: ak3825@columbia.edu.
authors.forename: Ana M
authors.initials: AM
authors.lastname: Kelly
authors.affiliation: Infection Prevention & Control, New York-Presbyterian/Columbia University Medical Center, New York, NY.
authors.forename: John F
authors.initials: JF
authors.lastname: D'Agostino
authors.affiliation: Infection Prevention & Control, New York-Presbyterian/Columbia University Medical Center, New York, NY.
authors.forename: Lilibeth V
authors.initials: LV
authors.lastname: Andrada
authors.affiliation: School of Nursing, Columbia University Medical Center, New York, NY.
authors.forename: Jianfang
authors.initials: J
authors.lastname: Liu
authors.affiliation: School of Nursing, Columbia University Medical Center, New York, NY; Mailman School of Public Health, Columbia University Medical Center, New York, NY.
authors.forename: Elaine
authors.initials: E
authors.lastname: Larson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016358:Contact Tracing / Q000191:economics*; D057210:Delayed Diagnosis / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006761:Hospitals; D006801:Humans; D017053:Infection Control / Q000191:economics*; D008297:Male; D008875:Middle Aged; D009519:New York City; D012189:Retrospective Studies; D014376:Tuberculosis / Q000175:diagnosis*; D055815:Young Adult
keywords: Delayed diagnosis; Disease outbreak; Infection control; Tuberculosis