Room to breathe: could use of TB PCR testing to determine infection risk reduce unnecessary respiratory isolation in hospital settings?

Résumé fourni par la source

BACKGROUND: Isolation rooms are in high demand in hospital settings, particularly in the post pandemic era. Suspected pulmonary tuberculosis can lead to lengthy periods of respiratory isolation. Current guidelines consensus requiring 3 negative TB smears on 3 consecutive days before deisolation predates access to tuberculosis polymerase chain reaction (TBPCR) testing (Jensen, P. et al, Centre for Disease Control, USA, 2005; Tuberculosis Coalition for Technical Assistance, The Hague, 2006). TBPCR testing could be used to rapidly risk assess and de-isolate suspected pulmonary TB cases. We wished to quantify potential savings of side room days in a general hospital setting. Method: We completed a retrospective case review of admissions where pulmonary tuberculosis was suspected, over a 6-month period, in a 400-bed district general hospital in London, UK. RESULTS: Thirty-nine patients were identified. 8 (21%) were diagnosed with pulmonary tuberculosis and 5 (13%) were smear positive for acid fast bacilli (AFB). In 31 (79%) no evidence of TB was found, 28 of which had been placed into an isolation room. TB negative patients occupied side rooms for a total of 188 bed days, mean 6.8 days per patient, prior to de-isolation or discharge (range 0 to 19 days). Notably only 61% of patients had 3 sputum AFB cultures sent on separate days during their admission. CONCLUSION: Over a sixth month period TB negative patients were isolated for a total of 188 bed days. Switching to a TB PCR based deisolation policy could save over 300 side room bed days per year, with implications for patient flow, patient safety and reduced healthcare costs.