Root cause analysis of nosocomial exposure to Tuberculosis

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Background: Understanding the root causes of nosocomial TB exposure is crucial for designing effective interventions to prevent transmission. Aim: To identify the root causes of nosocomial TB exposure. Methods: This retrospective cohort study enrolled culture-confirmed pulmonary TB cases at a medical center between 2016 and 2019. Based on findings of initial chest radiography and prescription of sputum study after hospitalization, index cases were categorized into 3 groups: (1) non-suggestive for TB; (2) suggestive without sputum study; or (3) suggestive with sputum study. Results: Of the 235 index cases included, 95 (40.4%) were categorized as non-suggestive CXR, 62 (26.4%) as suggestive without sputum study, and 78 (33.2%) as suggestive with sputum study. In Category 1, 52.6% developed typical CXR findings later after hospitalization. In Category 2, CXRs were misinterpreted in 72.6% and delayed reviewed in 27.4%. In Category 3, 51 (65.4%) cases experienced long turn-around time of sputum results. Nucleic acid amplification tests (TB-NAA) were not performed in 1 smear-positive and 23 smear-negative cases. Among the 13 cases with false-negative TB-NAA results, only one repeated testing. Conclusions: To mitigate nosocomial TB exposure, healthcare settings need heightened suspicion, prompt and accurate CXR interpretations, frontline TB-NAA testing, and consider repeat TB-NAA for initially negative yet highly suspicious cases. erj;66/suppl_69/PA1762/F1 F1 F1

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