Contact investigation after exposure to TB in healthcare workers

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Background: Testing for Tuberculosis (TB) Infection amongst healthcare workers after exposure is a crucial part of an Infection Control Plan. Aims/Objectives: The aim was to evaluate TB infection status in healthcare workers exposed to two patients with undiagnosed pulmonary TB who were hospitalized in two ICUs of “G. Papanikolaou” Hospital, Thessaloniki, Greece. Methods: Records of 93 ICU workers -nurses, doctors, physiotherapists, radiology assistants- were retrospectively reviewed. The majority of population in Greece is BCG vaccinated at the age of 6 years, therefore a two step approach was used with a TST that was followed by IGRA, if ≥5mm. Testing was performed 8 weeks after each TB diagnosis and included clinical examination, chest x-ray, TST and a questionnaire regarding medical history, duration of exposure, symptoms and history of previous TB disease and vaccination. Results: All workers had normal chest x-rays and no symptoms of active TB. 44 had TST <5mm. IGRA was performed in 49 with TST ≥5mm and in 5 with negative TST (immunosuppression, personal preference). Six participants had positive IGRA and were offered treatment- 5 accepted and 1 refused. Treatment was also suggested to 11 workers with negative IGRA for various reasons -immunosuppression or prolonged exposure and positive TST decades after BCG vaccination. 5 of them started treatment. 4 workers with positive TST, negative IGRA and moderate exposure were advised to repeat IGRA in two months. In one case, the second IGRA was positive, so treatment was initiated. Conclusion: Healthcare workers’ exposure to TB remains a risk and should not be neglected. The decision for TB infection treatment should be individualized.

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