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Difficulty of confining recalcitrant tuberculosis patients in isolation wards in Japan, 2013-2014
1Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan; Graduate School of Human Health Sciences, Department of Nursing Sciences, Tokyo Metropolitan University, Tokyo, Japan.
Objectives:
In Japan, approximately 7000 smear-positive tuberculosis (TB) cases were reported in 2014. According to the law, such patients must be isolated in a TB ward until they become at least sputum smear-negative. However, there are some recalcitrant patients who are difficult to isolate because of problematic behaviors. This study was conducted to characterize recalcitrant TB patients and determine why they left the hospitals and how they were followed up after they left.
Study Design:
Cross-sectional study.
Methods:
We sent a self-administered questionnaire to the hospitals in Japan with over 11 TB isolation beds, asking about recalcitrant TB inpatients from April 2013 through March 2014, in terms of demographic information, the reasons why they left, and how they were followed up.
Results:
A total of 38 recalcitrant patients were reported, of whom 15 (39.5%) self-discharged, eight (21.0%) were discharged, and 15 (39.5%) were transferred. Thirty-three (86.8%) were males. The main reason (52.6%) why the patients were considered recalcitrant was related to psychiatric problems. However, nine (23.6%) patients physically assaulted or insulted the staff members. Thirty-six (94.7%) were able to continue anti-TB treatment after they left the original hospital.
Conclusion:
Although the number of recalcitrant TB patients who were abusive was small, there should be TB facilities with law enforcement officials readily available to enforce isolation.
Insights
Recalcitrant tuberculosis (TB) patients in Japan often exhibit behavioral issues, with psychiatric problems being a common reason for non-compliance. Enhanced support and law enforcement presence are recommended for TB isolation facilities.
Area of Science:
- Public Health
- Infectious Diseases
- Psychiatry
Background:
- Tuberculosis (TB) remains a significant public health concern in Japan, with mandatory isolation for infectious patients.
- Recalcitrant TB patients pose challenges to isolation protocols due to problematic behaviors.
Purpose of the Study:
- To characterize recalcitrant TB patients in Japan.
- To identify reasons for hospital departure and post-discharge follow-up of these patients.
Main Methods:
- A cross-sectional study utilizing self-administered questionnaires.
- Data collected from Japanese hospitals with over 11 TB isolation beds regarding recalcitrant inpatients (April 2013-March 2014).
Main Results:
- 38 recalcitrant TB patients were identified; 39.5% self-discharged, 21.0% were discharged, and 39.5% transferred.
- Psychiatric issues (52.6%) were the primary reason for recalcitrance; 23.6% exhibited aggressive behavior towards staff.
- Despite challenges, 94.7% continued anti-TB treatment post-discharge.
Conclusions:
- A small but significant number of TB patients display abusive behaviors, necessitating specialized facilities.
- TB isolation facilities should have law enforcement readily available to manage recalcitrant cases and enforce isolation.
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