Delayed Suspicion, Treatment and Isolation of Tuberculosis Patients in Pulmonology/Infectious Diseases and Non-Pulmonology/Infectious Diseases Wards

Background/Purpose: Delayed diagnosis and isolation increases the risk of nosocomial transmission of tuberculosis (TB). To assess the risk of delayed management of TB, we analyzed the risk factors of prolonged delay ill isolation of smear-positive TB patients in pulmonology/infectious diseases and other wards ill a tertiary, teaching hospital. Methods: We enrolled smear-positive TB patients aged > 16 years with delayed respiratory isolation following hospitalization. Medical records were reviewed retrospectively. Time intervals between admission, Order of sputum acids-fast staining, initiation of anti-tuberculous treatment and isolation were compared between pulmonology/infectious diseases wards (PIWs) and other wards. Risk factors were analyzed in patients with prolonged isolation delay of > 7 days in individual groups. Results: Isolation was delayed ill 191 (73.7%) of 259 Hospitalized smear-positive TB patients. median Suspicion, treatment and isolation delays were 0, 3 and 4 days in PIWs and 1, 5 and 7 days ill other wards. for patients admitted to non-PIWs, atypical chest radiographs, symptoms without dyspnea or not being admitted from the emergency department (ED) were risk for prolonged isolation delay exceeding 7 days. The only risk factor for delayed isolation ill patients admitted to PIWs was age >= 70 years. Conclusion: Delays in suspicion, treatment and isolation of TB patients were longer ill non-PIWs. Clinicians should be alert to those admitted to non-PIWs with atypical chest radiographs, atypical symptoms, or not admitted from the ED. [J Formos Med Assoc 2009;108(3):202-209]