Related Experiment Videos
Observational study of the use of infection control interventions for Mycobacterium tuberculosis in pediatric
S E Kellerman1, L Saiman, P San Gabriel
1Investigation and Prevention Branch, Centers for Disease Control and Prevention, Altanta, GA 30333, USA.
Insights
Pediatric healthcare workers (HCWs) showed some compliance with tuberculosis (TB) infection control (IC) guidelines in isolation rooms. However, specific guidelines for pediatric facilities are needed to improve TB infection control practices.
Area of Science:
- Pediatric Infectious Diseases
- Hospital Infection Control
- Public Health
Background:
- Hospital transmission of Mycobacterium tuberculosis (TB) is a significant concern in adult facilities.
- Specific infection control (IC) guidelines for pediatric TB care are lacking.
- Pediatric healthcare worker (HCW) compliance with TB IC guidelines has not been previously assessed.
Purpose of the Study:
- To assess compliance with TB infection control (IC) practices in pediatric inpatient hospitals.
- To quantify adherence to IC guidelines by healthcare workers and visitors in pediatric TB isolation rooms.
Main Methods:
- An observational study was conducted in two pediatric inpatient hospitals from May 1996 to December 1997.
- A trained observer recorded entries/exits to TB isolation rooms and adherence to IC practices.
- Data collected included respirator use, door closure, and signage for 656 visits.
Main Results:
- During 30% of visits, doors to isolation rooms remained open for an average of 10 minutes.
- Respiratory protection was not used during 20% of visits, with overall appropriate use at 55%.
- HCWs were more likely to use respiratory protection with positive acid-fast bacillus smears, but professional vs. ancillary staff showed no difference.
Conclusions:
- This study is the first to quantify TB IC compliance in pediatric hospitals.
- While most visitors complied, discrepancies in IC practices were observed.
- Development of pediatric-specific TB IC guidelines, considering local epidemiology, is recommended over adapting adult guidelines.
Introduction:
Hospital transmission of Mycobacterium tuberculosis (TB) is a problem in US facilities where adults are treated. However, specific guidelines for facilities in which pediatric patients are cared for have never been defined, nor has any study attempted to assess pediatric health care worker (HCW) compliance with TB infection control (IC) guidelines.
Methods:
An observational study was performed in two pediatric inpatient hospitals from May, 1996, to December, 1997. A trained observer tallied persons (i.e. professional HCWs, ancillary HCWs and non-HCWs) entering and leaving occupied TB isolation rooms and recorded adherence with IC practices (e.g. proper use of respirators, prompt door closures, door signage).
Results:
Thirty children with confirmed or suspected TB were admitted during the study period and observed for a total of 242 h during which 656 visits by professional (n = 391) and ancillary (n = 131) HCWs and by family members (n = 134) were recorded. During 30% of visits doors remained open an average of 10 min, and during 20% of visits no respiratory protection was worn. In all, visitors wore the correct respiratory protection appropriately only 55% of the time. HCWs were more likely to wear respiratory protection when caring for children with a positive acid-fast bacillus smear than family members, but professional staff were no more likely than ancillary staff to do so.
Conclusions:
This is the first study to quantify compliance with IC practices for TB in pediatric hospitals. The majority of visitors entering TB isolation rooms occupied by children with confirmed or suspected TB complied with IC guidelines, but discrepancies were seen. Rather than relying on TB IC guidelines designed for adult facilities, guidelines specific for pediatric facilities that consider the local epidemiology of TB should be developed.