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Case study: an analysis of a tuberculosis post-exposure contact investigation originating from an undiagnosed oncology patient

Robbins, Emily (2016) Case study: an analysis of a tuberculosis post-exposure contact investigation originating from an undiagnosed oncology patient. Master Essay, University of Pittsburgh.

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Immunosuppressed patients, such as those undergoing chemotherapy and radiation, are at greater risk of developing tuberculosis (TB). Without prompt diagnosis the risk of nosocomial transmission is increased for patients and the staff providing care for them. At a large university-associated hospital an oncology patient developed pulmonary tuberculosis and went undiagnosed for several weeks. The patient exposed numerous other immunosuppressed patients to active TB. The infection control (IC) department of the hospital performed a contact investigation in an effort to prevent further transmission. This study is a retrospective analysis of the tuberculosis contact investigation conducted. The results of the contact investigation are reviewed, including the compliance rate of Tuberculosis Skin Test (TST) testing among notified patients as well as TST conversions due to the exposure. Quality improvement recommendations are suggested and an algorithm for use in future tuberculosis exposure events was developed and described. One hundred forty-two patients were identified as potential contacts and of these patients, 120 were successfully notified of the exposure. Among these patients, 39 (32.5%) completed the recommended testing and 81 patients (67.5%) were lost to follow-up. Of the 39 patients who completed the testing, there were no conversions as a result of the exposure. However, latent tuberculosis infection (LTBI) was identified in 3 patients. This study is of public health significance because it identified three important points related to infection control practices: First, a low testing compliance rate limits the full recognition of potential conversions. New patient notification methodologies should be adopted for future tuberculosis exposure events in an effort to improve compliance with recommended testing. Secondly, there were multiple cases of LTBI identified among patient contacts, which emphasizes the importance of TB screening in high-risk populations, such as oncology patients. Finally, the contact investigation conducted was highly resource intensive. Therefore, improved policy driven practices should be implemented and prioritized in hospital settings for TB control activities. The tuberculosis Contact Investigation Algorithm developed in response to this study is a useful tool for IC practitioners in future exposure events to prevent further transmission of TB.


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Item Type: Other Thesis, Dissertation, or Long Paper (Master Essay)
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Robbins, Emilyear70@pitt.eduEAR70
ContributionContributors NameEmailPitt UsernameORCID
Committee ChairFrank, Linda Rosefrankie@pitt.eduUNSPECIFIEDUNSPECIFIED
Committee MemberYassin, Mohamedyassinm@upmc.eduUNSPECIFIEDUNSPECIFIED
Committee MemberPokrywka, Marianpokrywkamf@upmc.eduUNSPECIFIEDUNSPECIFIED
Date: 18 November 2016
Date Type: Publication
Publisher: University of Pittsburgh
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Infectious Diseases and Microbiology
Degree: MPH - Master of Public Health
Thesis Type: Master Essay
Refereed: Yes
Date Deposited: 23 May 2017 19:06
Last Modified: 31 Jul 2020 19:12


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